Intracranial complication during insertion of a nasogastric tube.

Abstract

An attempt was made to insert a nasogastric tube through the right nares of a 45-year-old woman who had been vomiting for 2 weeks. She was fully alert, cooperative , and oriented before the procedure and had no known history of previous head trauma. Resistance was encountered during placement of the tube, and moderate amounts of bright red blood returned through the tube. Repeated injections of air were made through the tube, but no air sounds could be heard in the epigastrium . As the tube was advanced farther, the patient became increasingly somnolent. Again several hundred milliliters of air was injected, but the location of the tube was not established, and the tube was withdrawn. Simultaneously, the patient became completely unresponsive. A CT scan of the head was performed immediately and showed subdural pneumocephaly of the right anterior and middle cranial fossae and small collections of air in the right frontal and occipital