P1886 (S2338). - Transected Orogastric (OG) Tube Due to Facio-Mandibular Myoclonus in a Post-Cardiac Arrest Patient: A Rare Case of Incidental Gastrointestinal Tract Foreign Body and Its Endoscopic Removal
Yasir Saeed, MD1, Raghav Bassi1, Dasol Kang, MD1, Affaf Gul, MBBS2, Sulaiman Azeez, MD3; 1Lincoln Medical Center, Bronx, NY; 2Khyber Teaching Hospital, Peshawar, North-West Frontier, Pakistan; 3Lincoln Medical Center, Bronx, NY
Introduction: We have seen Foreign body ingestion in adults usually fish and chicken bones, toothpicks, etc, There have been also previously reported cases of endotracheal and tracheostomy tube presenting as an iatrogenic foreign body, however, Orogastric tube is a rare cause of incidental Gastrointestinal foreign body especially when Transected as a result of a myoclonic jerk. There is very little literature on endoscopic removal of such long foreign bodies. This case highlights a rare adverse event of Orogastric tubes and describes a successful endoscopic approach to management.
Methods: A 26-year-old female with a history of Hypertension, End-stage renal disease on Hemodialysis, subdural Hematoma with Craniotomy was admitted to the intensive care unit after a Pulseless electrical activity cardiac arrest with Return of Spontaneous circulation. The patient was intubated and underwent Targeted Temperature Management. The patient continued to require long term mechanical ventilation with an early tracheostomy. A 16 French Salem-Lump Orogastric tube was also Placed for enteral nutrition and medications. The patient developed post-hypoxic myoclonus involving the Facio-mandibular muscles. During the hospital course, it was found that the Orogastric tube apparently came out, so a new tube was inserted. A chest x-ray was done to confirm the placement and it showed that there was another tube paralleling the newly inserted Orogastric tube(Image 1). Gastroenterology was consulted. An esophagogastroduodenoscopy was done urgently, and a transected 44 cm distal end of the orogastric tube in the stomach antrum traversing the pylorus into the duodenum, was successfully removed using rat tooth forceps (Image 2,3). Discussion: Orogastric tubes are used for the treatment of ileus or bowel obstruction, enteral nutrition, administration of medications, or stomach lavage. Common complications include gut perforation, aspiration pneumonia, pulmonary abscess, gastritis, or ulcers from the chronic irritation of the gastrointestinal tract. The American Society for Gastrointestinal Endoscopy recommends urgent(within 24 hours) endoscopic removal for objects >6 cm above the proximal duodenum, as they can become lodged in the duodenal curve, and result in a 15-35% risk of perforation. Furthermore, surgical intervention becomes necessary when endoscopy has failed to remove large foreign objects that have reached the duodenum. Physicians should be cognizant of this rare adverse event of Orogastric tubes.
Endoscopic Image (Top) showing Gastric Body with Transected Orogastric tube(Right Arrow) and complete Orogastric tube(Down Arrow), Endoscopic Image (Down) showing Transected Orogastric tube in Gastric antrum traversing the pylorus into the duodenum.
The distal end of Transected Orogastric tube after endoscopic retrieval measuring 44 cm in Length.
Disclosures: Yasir Saeed indicated no relevant financial relationships. Raghav Bassi indicated no relevant financial relationships. Dasol Kang indicated no relevant financial relationships. Affaf Gul indicated no relevant financial relationships. Sulaiman Azeez indicated no relevant financial relationships.