Case Report
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World J Gastroenterol. Apr 28, 2014; 20(16): 4806-4810
Published online Apr 28, 2014. doi: 10.3748/wjg.v20.i16.4806
Nasogastric tube as protection for recurrent oesophageal stricture: A case report
Marek Woynarowski, Maciej Dądalski, Violetta Wojno, Mikołaj Teisseyre, Marek Szymczak, Anna Chyżyńska, Leszek Hurkała, Emil Płowiecki, Jakub Kmiotek
Marek Woynarowski, Maciej Dądalski, Violetta Wojno, Mikołaj Teisseyre, Jakub Kmiotek, Department of Gastroenterology, Hepatology and Feeding Disorders, Children’s Memorial Health Institute, Warsaw 04-730, Poland
Marek Szymczak, Anna Chyżyńska, Department of Pediatric Surgery and Organ Transplantation, Children’s Memorial Health Institute, Warsaw 04-730, Poland
Leszek Hurkała, Emil Płowiecki, Balton Ltd., Warsaw 03-152, Poland
Author contributions: Woynarowski M, Dądalski M, Wojno V, Teisseyre M, Szymczak M, Chyżyńska A and Kmiotek J provided medical care to the patient and performed the endoscopic therapy; Woynarowski M, Dądalski M, Wojno V and Teisseyre M developed the idea for the perforated nasogastric tube; Hurkała L and Płowiecki E prepared the prototype of the perforated nasogastric tube; Woynarowski M wrote the paper.
Correspondence to: Marek Woynarowski, MD, PhD, Department of Gastroenterology, Hepatology and Feeding Disorders, Children’s Memorial Health Institute, Al. Dzieci Polskich 20, Warsaw 04-730, Poland. m.woynarowski@czd.pl
Telephone: +48-22-8157386 Fax: +48-22-8157382
Received: January 1, 2014
Revised: February 20, 2014
Accepted: March 7, 2014
Published online: April 28, 2014
Processing time: 117 Days and 15.1 Hours
Abstract

This report presents the case of an 8.5-year-old boy with Down syndrome after experiencing extensive caustic injury to the oesophagus and stomach resulting from the accidental ingestion of concentrated sulphuric acid. The patient had undergone 32 unsuccessful endoscopic oesophageal stricture dilatations and stenting procedures performed over a period of 15 mo following the accident. Surgical reconstruction of the oesophagus was not possible due to previous gastric and cardiac surgeries for congenital conditions. Before referring the patient for salivary fistula surgery, the patient received a nasogastric tube with perforations located above the upper margin of the oesophageal stenosis for the passage of saliva and fluid. The tube was well tolerated and improved swallowing; however the backflow of gastric contents caused recurrent infections of the respiratory tract. To overcome these problems, we developed a double lumen, varying diameter, perforated tube for protection of the oesophageal closure. This nasogastric tube was found to be safe and decreased the need for hospitalization and further endoscopic procedures. This newly developed tube can thus be considered as a treatment option for patients with recurrent oesophageal stenosis and contraindications for surgical oesophageal reconstruction.

Keywords: Corrosive oesophageal stenosis; Oesophageal dilatation; Oesophageal stenting; Nasogastric tube

Core tip: This report presents the design and use of a perforated nasogastric tube for passage of saliva and fluids in a paediatric patient who was unsuitable for oesophageal reconstructive surgery. The perforated tube was safe, well tolerated and reduced the need for hospitalization and endoscopic oesophageal dilatation. Therefore, this newly developed perforated nasogastric tube can be used as an alternative method for corrosive oesophageal stenosis therapy in patients who cannot undergo reconstructive surgery.