Endoscopic removal of a nasogastric tube accidentally ligated to the duodenum after open abdominal surgery.

A 61-year-old man underwent open abdominal surgery for primary repair of a duodenal perforation. Preoperatively, a nasogastric tube had been inserted into the stomach for decompression. An attempt was made to remove the tube 6 days postoperatively but this was not possible because of marked resistance. Upper gastrointestinal endoscopy revealed that the nasogastric tube and granulation tissue were intertwined with a 3-0 Vicryl suture at the second portion of the duodenum (●" Fig.1a). A rat-tooth forceps and snare were used to try to sever the suture; however, the tube was not extirpated. Next, an endoscopic loop cutter (Olympus Medical Systems Corp., Aomori, Japan) was inserted into the side hole of the endoscope and an attempt was made to cut the suture (●" Fig.1b). This effort was unsuccessful. The loop cutter had to be pulled forcibly while holding the suture, which finally resulted in the stitch being severed. The nasogastric tube was then removed successfully without further complications (●" Fig.1c). At the 1-week follow-up, the patient exhibited no abnormalities. Very few cases of a nasogastric tube unintentionally sutured to the gastrointestinal tract have been reported worldwide [1– 5]. This is the first reported case of this happening in the duodenum. If resistance is felt when pulling on a nasogastric tube, the tube should be left intact and endoscopy should be performed to identify the cause, as vigorous attempts to extirpate the tube may result in perforation or severe bleeding. When the tube is trapped in the anastomotic site, it is safe to perform endoscopic treatment 2 weeks postoperatively [1,3]. However, in our case, endoscopic treatment was performed early and additional force was applied to the loop cutter to cut the tube. Despite this, it was a safe procedure because the tube was trapped in a comparatively intact part of the duodenum. Endoscopic treatment was safe, less expensive, andmore convenient. It should be considered a first choice for this complication.