Simple measures to prevent a massive upper gastrointestinal bleed.

Nasogastric (NG) tube is frequently used in clinical practice for a variety of indications; however, NG tubes are not without risks, and there are a multitude of gastrointestinal complications that are associated with their use. Simple precautions can help prevent these NG tube-related injuries.

A 23‐year‐old man was admitted after a motor vehicle accident. He was found to have mesenteric dissection and underwent left hemicolectomy. A nasogastric (NG) tube was placed on continuous suction for postoperative ileus. The NG tube output was initially bilious, however, later transitioned to bright red blood.

What is the etiology of the upper gastrointestinal (GI) bleed in our patient?

Esophagogastroduodenoscopy revealed clean base ulcers in the esophagus (Fig. 1A) and gastric cardia (Fig. 1B). NG tube‐induced trauma resulted in a GI bleed in our patient.

Figure 1

Esophagogastroduodenoscopy showing (A) Ulcer in the distal esophagus. (B) Ulcer in the gastric cardia.

Nasogastric tubes are flexible single or double lumen tubes which are commonly used in clinical practice. Traumatic injury to the GI mucosa may occur during NG tube insertion and can result in GI bleed, especially in patients with coagulopathy. Prolonged use of NG tube can cause ulcer formation due to continuous irritation and pressure necrosis.

Short‐term use of flexible tubes, minimal manipulation, irrigation, and low intermittent suction decreases the risk of trauma 1. A double lumen Salem Sump tube is the preferred tube for gastric decompression. NG tube should be avoided in patients with esophageal varices especially after recent band ligation. Any change in the hemodynamic status of the patient or type of drainage from the NG tube requires immediate evaluation of the patient.

Authorship

RB: Endoscopist, manuscript editing and final approval. NV: Manuscript preparation. RACC: Endoscopist. IR: Image collection and editing. IS: Manuscript preparation.

Conflict of Interest

None declared.