Nasogastric tube syndrome

Case; 65 years old female admitted to ICU 9 days ago with small bowel obstruction. Pt. is now stable and is about to get transferred out of the unit. Patient suddenly starts complaining of a choking sensation with two hands on the neck. Monitor shows oxygen desaturation. Patient was intubated emergently. No laryngeal or vocal edema was visualized but vocal cord paralysis was noted. What is the probable diagnosis?

Answer: Nasogastric tube syndrome 

Nasogastric tube syndrome was described more than four decades ago by Sofferman and Coll. It is a life-threatening complication of an indwelling (more than a week) nasogastric tube. The syndrome may present as complete vocal cord abductor paralysis. The syndrome is thought to result from perforation of the NG tube-induced esophageal ulcer and infection of the posterior cricoid region (post-cricoid chondritis) with subsequent dysfunction of vocal cord abduction. Unilateral paralysis of the cord is also described. Treatment is the protection of the airway, removal of the NG tube, and antibiotics. Some advocate antireflux therapy too. Another variant is described with no esophageal ulcer but possibly because of ischemia of the laryngeal abductor muscle secondary to physical compression of the postcricoid blood vessels by NG tube.

Probably bigger the size, the higher the chances of NGT-syndrome.

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References:

1. Sofferman RA, Hubbell RN. Laryngeal complications of nasogastric tubes. Ann Otol Rhinol Laryngol. 1981 Sep-Oct;90(5 Pt 1):465-8. doi: 10.1177/000348948109000510. PMID: 7305201..

2. Nayak G, Virk RS, Singh M, Singh M. Nasogastric Tube Syndrome: A Diagnostic Dilemma. J Bronchology Interv Pulmonol. 2018 Oct;25(4):343-345. doi: 10.1097/LBR.0000000000000507. PMID: 29771772.

  

3. Isozaki E, Tobisawa S, Naito R, Mizutani T, Hayashi H. A variant form of nasogastric tube syndrome. Intern Med. 2005 Dec;44(12):1286-90. doi: 10.2169/internalmedicine.44.1286. PMID: 16415551.

  

4. Kanbayashi T, Tanaka S, Uchida Y, Hatanaka Y, Sonoo M. Nasogastric Tube Syndrome: The Size and Type of the Nasogastric Tube May Contribute to the Development of Nasogastric Tube Syndrome. Intern Med. 2021 Jun 15;60(12):1977-1979. doi: 10.2169/internalmedicine.6258-20. Epub 2021 Feb 1. PMID: 33518566; PMCID: PMC8263194.