A Case of Esophagogastric Ulcer in Patient with Nasogastric(NG) Tube Remnant on Stomach

Post stroke dysphagia is a common disorder presented in 30-65% of stroke patients. It can result in severe complication such as aspiration pneumonia. Thus nutritional support with nasogastric(NG) feeding tube is needed in these patients. But this method is not recommended more than 4 weeks. In the patients with severe dysphagia, the percutaneous endoscopic gastrostomy(PEG) is recommended in respective with the complication and prognosis.

We experienced a case of 46 year-old-male with esophagogastric ulcer because of remnant NG feeding tube on stomach. He had not a special past history until admission. He was bedridden and quadriplegic state due to spontaneous intracranial hemorrhage on both fronto-parietal lobe and subdural hemorrhage. NG feeding tube(polyvinyl chloride, 16 French) was inserted because of severe dysphagia and the clinicians attempted the PEG tube insertion but removed the PEG tube due to the sepsis with wound infection and reinserted NG feeding tube. After transfer into our hospital, a sudden blood clot from NG feeding tube was drained. We performed gastrofibroscopic examination and found NG feeding tube remnant (23cm) on stomach. It was removed and multiple esophagogastric linear ulcer with hemorrhage due to exposed vessel was observed. He obtained nutrition by total parenteral nutrition for 4 weeks after that. On follow up gastrofibroscopic examination, esophagogastric ulcers were being healing. So we tried PEG tube insertion again but failed because of granulation tissue on previous PEG tube insertion site and inserted NG feeding tube. After 3 months, he was inserted PEG tube and being supported sufficient nutrition.

Many complications are associated with the prolonged NG feeding tube insertion. So recent studies showed alternative method in case of prolonged dysphagia. We report a case with esophagogastric ulcer associated with remnant NG feeding tube on stomach.