A man in his sixties developed acute upper airway obstruction five days after nasogastric tube insertion for conservative management of small bowel obstruction. Initial symptoms were subtle, with preserved oxygen saturation and phonation despite progressive airway compromise. Flexible nasal endoscopy demonstrated marked supraglottic and hypopharyngeal oedema, and contrast-enhanced CT confirmed severe supraglottic narrowing without evidence of abscess or mass lesion. Despite prompt treatment with systemic corticosteroids and nebulised adrenaline, respiratory distress progressed, necessitating awake fibreoptic intubation, intensive care admission, and subsequent surgical tracheostomy. Gradual clinical improvement followed, with resolution of airway oedema and recovery of voice and swallowing function prior to discharge. This case highlights nasogastric tube syndrome as an under-recognised cause of delayed, life-threatening airway obstruction.
Rajamanickam et al. (Fri,) studied this question.