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Case report
Challenging removal of a knotted nasogastric tube following insertion under general anaesthetic
  1. Michael Conroy1,2,
  2. Katherine Wichmann2,
  3. Nicholas Farkas2 and
  4. Valerio Di-Nicola2
  1. 1Urology, Medway Maritime Hospital, Gillingham, UK
  2. 2General Surgery, Worthing Hospital, Worthing, UK
  1. Correspondence to Dr Michael Conroy; mjeconroy{at}


A 74-year-old man presented with acute small bowel obstruction secondary to recurrence of a caecal tumour. The patient underwent laparotomy and formation of loop ileostomy and had a nasogastric tube (NGT) inserted in the theatre. A decision was made to remove the patient’s NGT postoperatively, which was found to be stuck. High-quality imaging demonstrated a knot in the tube within the nasopharynx; so, subsequent removal via the oral route necessitated sedation. This case highlights the importance of considering rare or unusual complications of NGT insertion when a patient describes more pain or discomfort than would otherwise be expected. The clarity of imaging highlights clearly the underlying findings when compared with the few other documented cases. We offer a number of learning points specific to this complication.

  • ear
  • nose and throat/otolaryngology
  • surgery
  • general surgery

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  • Contributors MC: Involved in creation of the initial draft, revision of the draft and approval of the final manuscript. Revision of the final manuscript following feedback from peer review. KW: Involved in creation of the initial draft, revision of the draft and approval of the final manuscript. NF: Involved in the initial draft production, critical revision of the draft and approval of the final manuscript, reviewed the manuscript after peer-review comments. VD-N: Consultant in charge of patient care, assisted in critical revision of the draft and approved the final manuscript. All authors are accountable for the work produced.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer-reviewed.