CMAJ • March 11, 2008 • 178(6)
© 2008 Canadian Medical Association or its licensors
6 68 80 0
nasogastric tube. At the time of the inci-
dent, the patient’s hands were re-
strained, and he had a Glasgow coma
score of 10 (his eye, verbal and motor
responses were scored as 3, 2 and 5 re-
spectively). The patient’s right upper-
limb strength was 4 (out of 5). He had
last received food through the nasogas-
tric tube at 10 pm, and he was well at
1 am when he was repositioned onto his
side. At 5 am, a nurse discovered that
his nasogastric tube was disconnected.
The bed sheets and the back of his shirt
had been covered in gastric juices. The
skin on his back was erythematous and
tender, and there were satellite lesions
surrounding the main lesions (Figure 1).
48-year-old man who had a re-
cent right-sided motor stroke
was receiving food through a
The central portion of his back was
insensate. His vital signs were stable.
His clothes and bed sheets were
changed immediately; however, he may
have been in contact with the gastric
juices for a couple of hours. A plastic
surgeon confirmed that the patient had
second-degree burns over 8% of his
body and that he had peripheral first-
degree burns. The patient received a
tangential skin graft (Figure 2), and he
This report illustrates the dangers of
prolonged contact of gastric juices with
skin. A similar, yet less severe, incident
has been reported.1,2
Certain factors may have placed our
patient at increased risk, including dis-
orientation and the use of restraints,
which may have prevented him from
turning his back away from the gastric
juices. The timing of the incident dur-
ing the early morning, when the lights
are routinely dimmed, may also have
hampered early detection.
Jayant Daniel Thorat MS MCh(NS)
Ernest Wang MBBS FRCS
Department of Neurosurgery
National Neuroscience Institute
Danbury CM. Acid burns and feeding tubes. Pa-
tients should not be allowed to lie in their own
vomit: gastric acid burns. BMJ2002;325:496.
2. Alvi R, Walmsley P, James MI. Deep dermal burn
due to contact with stomach contents. Burns
Gastric acid burns because of a disconnected nasogastric tube
Figure 1: After being in contact with gastric juices for several
hours, the skin on the patient’s back was erythematous and ten-
der, with multiple satellite lesions (arrowheads) surrounding the
main lesion (arrows).
Figure 2: The patient underwent a tangential skin graft after re-
ceiving second-degree burns over 8% of his body and peripheral
Competing interests:None declared.
Acknowledgements: We thank Dr. Timothy Shui
for his photography assistance.