Hazem Kafrouni
It is common to use in a surgical setting a Naso Gastric (NG) tube to empty the stomach, monitor the occurrence of bowel occlusion and detect the presence of a gastric leak after major abdominal surgery through the injection of methylene blue.
A 68-year-old male patient presented to the operating room for scheduled laparoscopic cholecystectomy. After tracheal intubation and commencement of surgery, an 18 Fr. NG tube was inserted blindly through the nostril with no means of assessing its position to assess the integrity of the stomach. A solution of methylene blue was prepared and 240 ml were injected in the NG tube. Upon applying negative pressure suction on the NG, a noticeable change in airway pressure was noted and investigation through the use of fiber optic vision revealed the presence of bluish liquid in the bronchi. The NG tube was then re-inserted, the surgeon made the final confirmation of its proper placement within the stomach and the surgery continued uneventfully. Postoperative chest x-ray was suggestive of chemical pneumonitis and emphysema. Patient was first admitted to the intensive care unit for close monitoring, to be then transferred to the ward and later discharged on post-operative day three. With little information concerning such accidents, further studies concerning the effect of MB on the lungs are highly needed. We report this case due to its rare incidence, favorable outcome and potential in illustrating the importance of proper verification of NG tube placement.
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