Skeletal muscle necrosis in severe falciparum malaria

Abstract

inadvertent tracheobronchial intubation,2 pneumothorax,3 and broncho- pleural fistula.4Displacement of the tube during feeding may cause aspiration pneumonia.'Weighted tubes have a lower risk of misplacement and displacement but are more difficult to pass in uncooperative patients.The complication reported here was potentially serious.We do not know of any previous reports of difficulty in removing a nasogastric tube or of the tube breaking.The manufacturers (Vidomedex) admit that removal can be difficult and suggest that the nostril should be examined before the tube is passed.If difficulty is encountered during removal they suggest trying to advance the tube again, retrieve the weight from the pharynx, cut it off, and remove it through the mouth.The firm impaction of the weight made subsequent advance or withdrawal of the tube impossible in our patient.It is easy to see how the weight could become lodged behind a septal spur or a turbinate bone on removal.In such cases we therefore agree with the manufacturers' advice that per oral removal should be tried.In a patient with a narrow nostril a tube without a weight passed over a guidewire may be safer.1 James RM.An unusual complication of passing a narrow bore nasogastric tube.