Impacted Nasogastric Tube Embedded in the Oropharyngeal Muscle: A Rare Mechanical Complication of Long-Term Enteral Feeding

Abstract

Aims: Nasogastric tube (NGT) insertion is a commonly performed procedure for enteral nutrition and gastric decompression. Although it is generally considered safe, complications ranging from minor mucosal injury to perforation, infection and vascular injury have been reported. Mechanical embedding of an NGT within the oropharyngeal musculature is exceedingly rare. This report describes a case of an impacted NGT embedded in the oropharyngeal muscle and its successful management. Presentation of Case: A 61-year-old man with upper oesophageal squamous cell carcinoma underwent endoscopic placement of a nasogastric (Ryle's) tube for enteral feeding because of dysphagia. Following radiotherapy, his swallowing improved, and tube removal was planned. Bedside removal was unsuccessful. Upper gastrointestinal endoscopy demonstrated impaction of the tube within the right lateral wall of the oropharynx. Non-contrast computed tomography of the neck revealed approximately 2.5 cm penetration of the tube into the right oropharyngeal musculature, without evidence of abscess, haematoma or vascular involvement. A kink in the tube was also noted within the nasopharynx. The tube was successfully removed by gentle external traction. Post-removal endoscopy showed a localised ulcer with mild oozing at the impaction site, without active bleeding. The patient was managed conservatively and recovered uneventfully. Conclusion: Impaction of an NGT within the oropharyngeal musculature is a rare complication of long-term enteral feeding. Endoscopic and radiological evaluation can facilitate safe removal and favourable clinical outcomes.