Persistent vomiting in neurocritical care: Gastroesophageal junction nasogastric tube malposition as a diagnostic pitfall—A case report

Vomiting in neurocritical care patients is often attributed to raised intracranial pressure or neurological deterioration, which may delay consideration of reversible mechanical causes. We report a postoperative neurosurgical patient with chronic neurobrucellosis and raised intracranial pressure who developed recurrent vomiting and desaturation following initially confirmed nasogastric (NG) tube placement. His neurological status remained stable. Point-of-care ultrasound failed to demonstrate the NG tube tip within the stomach, and subsequent abdominal radiography revealed proximal migration of the tube, with looping and termination at the gastroesophageal junction. The tube was repositioned, and enteral feeding was subsequently changed to nasojejunal feeding because of the ongoing aspiration risk. Vomiting resolved and oxygen requirements decreased. This case highlights the importance of reassessing NG tube position when persistent vomiting or aspiration occurs, even after initial radiographic confirmation. Point-of-care ultrasound may serve as a useful bedside adjunct for detecting suspected malposition and prompting definitive radiographic confirmation .