Case History:
Post-pyloric feedings are an essential strategy in critically ill
patients to facilitate tube feed delivery and mitigate aspiration
events. As with other feeding modes, Dobhoff tubes also require a
clinical and radiologic confirmation for proper placement.
Question: What are the implications of incorrect Dobhoff tube
placement?
Answer: Dobhoff tubes can easily perforate vital surrounding
structures and placement should be confirmed.
A 66-year-old male with several comorbidities presented with altered
mental status and septic shock requiring a prolonged stay in the
intensive care unit. A nasogastric tube was placed and confirmed via
visual observation on consecutive abdominal radiographs (Figure 1,
Figure 2); tube feeding was subsequently initiated. Within a few hours,
the patient began experiencing desaturation episodes with an emergent
computed tomography (CT) of the chest and abdomen (Figure 3, Figure 4),
revealing a new left hydropneumothorax and pleural effusion from
iatrogenic puncture of pleura. Tube feedings were stopped and a chest
tube was placed immediately with drainage and eventual seal.