Misplacement of a Naso-Intestinal Feeding Tube Into the Pleural Space in a Patient With Nasopharyngeal Carcinoma: A Case Report

Postpyloric enteral feeding is recommended for ICU patients at high risk of aspiration. However, blind placement carries a rare yet potentially life-threatening risk of tube misplacement into the pleural cavity. We present a case in which blind insertion of a fine-bore naso-intestinal tube led to intrapleural malposition in an elderly patient with a history of radiotherapy for nasopharyngeal carcinoma (NPC). A 78-year-old Chinese man with severe dysphagia following radiotherapy for NPC underwent tracheotomy due to respiratory failure and was subsequently transferred to the ICU. The naso-intestinal tube was inserted blindly, and its position was considered appropriate based on limited fluid aspiration and auscultation. Nine hours later, chest radiography revealed that the tube had traversed through the trachea, entered the right lower-lobe bronchus, extended into the pleural cavity, and terminated mid-thorax. The tube was promptly removed and accurately repositioned into the stomach under laryngoscopic guidance. Blind postpyloric tube placement in patients with radiation-induced anatomical and neurological changes following NPC may result in silent intrapleural misplacement. Immediate pH testing combined with radiographic confirmation is crucial to prevent this potentially fatal complication.