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Management of oral-gastric lavage tube impaction of the esophagus
Abstract
Oral-gastric lavage is an important tool in the management of oral toxic ingestions. An unusual complication of the impaction of the oral-gastric tube in the esophagus is described. This is the first report of the use of flexible endoscopy in the management of the complication.
Removal of gastric content, followed by administration of activated charcoal and cathartics, is often recommended and routinely performed in acute toxic ingestions, excepted for several well known contraindications. Although its influence on clinical outcome has never been clearly demonstrated, early administration of activated charcoal is able to reduce the biodisponibility of many toxines. As it is almost devoided of side effects, a wide use may however be recommended. Conversely, induction of emesis and gastric lavage have both questionable effectiveness and are sometimes responsible for severe complications. A less sytematic and more rational use of these techniques is thus recommended. This paper, which is published is in two parts, is a review of literature about this topic and gives practical guidelines for the clinician.
A 19-year-old woman underwent multiple attempts at orogastric lavage before success 5 h after ingesting approximately 24 grams of ibuprofen in a suicide attempt. Activated charcoal was administered via the lavage tube. She vomited charcoal shortly after administration and began experiencing difficulty breathing and an increase in the pitch of her voice. A chest X-ray study showed a widened mediastinum, pneumopericardium, and subcutaneous emphysema consistent with esophageal perforation that was confirmed by computed tomography scan. Surgical exploration revealed a tear in the proximal posterior esophagus with charcoal in the posterior mediastinum. She remained intubated for 7 days and was discharged 14 days after admission. This is a report of esophageal perforation with activated charcoal contamination of the mediastinum after gastric lavage. The risks and benefits of this procedure should be carefully considered in each patient prior to its use. Awake patients should be cooperative with the procedure to minimize any risk of trauma to the oropharynx or esophagus.
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