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Misplaced gastric tube: a case of oesophageal perforation in a preterm neonate
  1. Claire L Granger1,2,
  2. Charlotte Ashton1,
  3. Robert Tinnion1
  1. 1 Newcastle Neonatal Service, Ward 35 Neonatal Unit, Royal Victoria Infirmary, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
  2. 2 Translational and Clinical Research Institute, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, UK
  1. Correspondence to Dr Robert Tinnion, Newcastle Neonatal Service, Ward 35 Neonatal Unit, Royal Victoria Infirmary, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne NE7 7DN, UK; robert.tinnion{at}nhs.net

http://dx.doi.org/10.1136/archdischild-2022-323828

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    A 25-week infant, born in a level one unit, was intubated, ventilated and transferred to the tertiary neonatal centre without incident. He had acute respiratory collapse on day 2 with a right-sided tension pneumothorax (figure 1A), which was drained. He remained stable until day 7 when he deteriorated, with increased oxygen requirement and poor feed tolerance (figure 1B). On review, there were gastric tube aspirates over the preceding days with high pH (>6–8), consisting mainly of large volumes of undigested milk.

    Figure 1

    X-rays on (A) day 2 and (B) day 7.

    Questions

    1. What do these radiographs show?

    2. What is your differential diagnosis?

    3. What would your concerns be?

    4. How would you manage this?

    Answers can be found on page 2.

    ANSWERS TO THE QUESTIONS ON PAGE 1

    Answers

    1. The first image shows a right-sided tension pneumothorax. The gastric tube tip projects …

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    Footnotes

    • Twitter @clairelgranger

    • Contributors CLG, RT and CA were responsible for the original concept for the article. CLG wrote the initial manuscript. RT and CA were both involved in editing and rewriting.

    • 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.

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