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Oesophageal-pleural fistulation identified through repeated malpositioning of nasogastric tubes
  1. Laura Josephine Cheetham1,
  2. Edwin Mitchell2
  1. 1Aneurin Bevan University Health Board, Newport, UK
  2. 2Worcester Acute Health Trust, Redditch, UK
  1. Correspondence to Dr Laura Josephine Cheetham, josiech{at}


Two previously fit and healthy males with acute onset dyspnoea and respiratory failure required invasive ventilation for respiratory failure. Insertion and correct positioning of nasogastric tubes (NGT) proved to be difficult repeatedly in both cases over the course of a number of days. Repeated imaging found NGT tips sited in varied, atypical positions including extension into the hemithoraces. Delineation of repeated malpositioned NGTs identified oesophageal perforations in the case of both patients, one with fistulation into the right pleura and the other into the left pleura. Both patients developed an empyema ipsilateral to the side of fistulation. Both patients died, with subsequent postmortems concluding one patient to have experienced a spontaneous out-of-hospital oesophageal perforation, and the second patient’s perforation developing as a consequence of a distal oesophageal squamous cell carcinoma. These two cases highlight the importance of questioning the possibility of underlying oesophageal pathology promptly if repeated NGT insertions are unsuccessful or imaging reveals unusual transit paths of NGTs.

  • sdult intensive care
  • parenteral / enteral feeding
  • radiology
  • pneumonia (respiratory medicine)
  • oesophagus

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  • Contributors LJC followed cases, collected data, attended postmortem and drafted case report. EM advised on design of case reports and evaluated and edited case report.

  • 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 Not required.

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