A Potentially Lethal Course of a Nasogastric Tube: Case Report

Nasogastric tube (NGT) insertion is a common procedure, often performed blindly. We report a rare, near-fatal complication in a 44-year-old woman where an NGT traversed the internal jugular vein, superior vena cava, and perforated the right atrium into the pericardial cavity. Prompt imaging and surgical retrieval via sternotomy prevented tamponade or exsanguination. No esophageal injury was found; the likely entry point was the nasopharynx. A sealed duodenal perforation was managed conservatively. This case emphasizes the importance of verifying NGT placement before use and the role of confirmatory X-ray.