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Nasogastric tube knotting with tracheoesophageal fistula - a rare association.

The nasogastric tube is used extensively in medical practice. However, this innocent-looking tube can at times cause unexpected complications especially in patients with preexisting risk factors. A 25-year-old male was referred to our hospital with a blocked and impacted nasogastric tube which had been inserted to maintain his nutritional status after he sustained a caustic injury to the esophagus in an attempted suicide. Esophagoscopy was done, the knotted nasogastric tube was retrieved and a tracheoesophageal fistula was detected at the site of impacted knot. However, the patient succumbed to ARDS and sepsis before definitive surgery could be done. Nasogastric intubation is not a simple procedure as is the general concept and it should not be done in cases of caustic injury to the esophagus because of increased risk of complications in the face of preexisting inflammation. To our knowledge, this is the first case report of its kind in the literature review.