From the Research
Yes, a nasogastric (NG) tube insertion can cause pneumoperitoneum, though this is a rare complication. Pneumoperitoneum occurs when air enters the peritoneal cavity, and during NG tube placement, the tube can potentially perforate the esophagus, stomach, or duodenum, allowing air to escape into the peritoneal space.
Risk Factors and Signs
Risk factors include forceful insertion, anatomical abnormalities, previous surgeries, and patient agitation during placement. Signs of this complication include sudden abdominal pain, distension, rigidity, and respiratory distress following tube insertion.
Diagnosis and Management
If pneumoperitoneum is suspected after NG tube placement, the tube should be removed immediately, the patient should be kept nil by mouth, and urgent surgical consultation should be obtained. Imaging studies such as an upright chest X-ray or abdominal CT scan can confirm the diagnosis by showing free air under the diaphragm, as noted in a case report from 1.
Prevention
To minimize this risk, proper technique is essential, including appropriate patient positioning, gentle advancement of the tube, and confirmation of proper placement through aspiration of gastric contents and radiographic verification before use, as suggested by 2 and further supported by the use of advanced techniques like electromagnetically guided nasogastric tubes 3.
Clinical Significance
While pneumoperitoneum can be a significant complication, its incidence and clinical significance, especially in relation to procedures like PEG placement, have been studied, showing that in many cases, pneumoperitoneum may not be of clinical significance in the absence of symptoms 4. However, given the potential for severe outcomes, healthcare providers should maintain a high index of suspicion for this complication, especially when patients develop acute abdominal symptoms following NG tube insertion.