Esophageal perforations are associated with high morbidity and mortality and can have iatrogenic or spontaneous causes. Nasogastric tube intubation, while generally considered a safe procedure, can be a very rare iatrogenic cause. A 61-year-old male underwent direct laryngoscopy, total laryngectomy, and esophageal dilation with complex closure for laryngeal obstruction and tracheocutaneous fistula secondary to laryngeal cancer. He experienced an esophageal perforation secondary to nasogastric tube advancement and required emergent surgical exploration via thoracotomy and laparotomy with washout and gastrostomy tube placement. Notably, the tube penetrated the cervical esophageal mucosa, tracked distally within a submucosal plane, and ultimately perforated the stomach at the gastroesophageal junction. He subsequently experienced recurrence of his esophageal strictures and became gastrostomy tube dependent. Signs and symptoms of esophageal perforations can present in a vague and nonspecific manner, mimicking those of other disorders. When a perforation is suspected, a chest X-ray can be used to identify early clues, and a contrast esophagogram and CT scan can be used to confirm the diagnosis. Although uncommon, esophageal perforation should be considered in any patient who develops acute symptoms following nasogastric tube manipulation. Prompt diagnosis and early surgical intervention are essential for optimal outcomes.
Dixon et al. (Sun,) studied this question.