CC BY-NC-ND 4.0 · Ann Natl Acad Med Sci 2021; 57(02): 117-119
DOI: 10.1055/s-0041-1726153
Case Report

Rare Complication of Nasogastric Tube Knotting around Endotracheal Tube in an Anesthetized Patient Undergoing Surgery

Suvidha Sood
1   Department of Anaesthesia, ESIC Medical College and Hospital, New Delhi, India
Yeesha Aggarwal
1   Department of Anaesthesia, ESIC Medical College and Hospital, New Delhi, India
Anoj Kumar
1   Department of Anaesthesia, ESIC Medical College and Hospital, New Delhi, India
› Author Affiliations


We report a case of successful management of a rare incidence and avoidance of complication of Ryle’s tube knotting around endotracheal tube. A vigilant anesthesia team prevented fatal complications of intraoperative accidental extubation and ventilation impairment which could have resulted into respiratory distress.

Publication History

Article published online:
13 April 2021

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  • References

  • 1 Kubo K, Nakao S, Kawabata Y, Nishimae H, Masuko S, Shingu K. An unusual case of airway obstruction at the tip of an endotracheal tube caused by insertion of a nasogastric tube. J Anesth 2008; 22 (01) 52-54
  • 2 Kiran S, Kaur K. Coiled ERCP catheter in the oral cavity. Internet J Anesthesiol 2009; 19 (02) Doi: DOI: 10.5580/d72.
  • 3 Au-Truong X, Lopez G, Joseph NJ, Salem MR. A case of a nasogastric tube knotting around a tracheal tube: detection and management. Anesth Analg 1999; 89 (06) 1583-1584
  • 4 Hariharan U, Bhasin N, Gupta N, Senapati NN, Sanyal K. Ryle’s tube knotting around the tracheal tube: twin Magills forceps tour rescue. J Anest & Intens Care Med 2017; 2 (02) 1-2
  • 5 Acharya G, Arora KK, Kumar D. Nasogastric tube coiled around endotracheal tube. J Anaesthesiol Clin Pharmacol 2014; 30 (04) 584-586
  • 6 Bautista EM. Complications of nasogastric tube insertion. Chest 1988; 93 (05) 1119-1120
  • 7 Pousman RM, Koch SM. Endotracheal tube obstruction after orogastric tube placement. Anesthesiology 1997; 87 (05) 1247-1248
  • 8 Dorsey M, Schwinder L, Benumof JL. Unintentional accidental extubation by orogastric tube removal. Anesth Rev 1988; 15: 30-33
  • 9 Sinha PK, Koshy T, Sivakumar P. Nasogastric tube withdrawal: an unusual cause of accidental extubation and near cardiac arrest. J Cardiothorac Vasc Anesth 2000; 2 (01) 105-107
  • 10 Kumar DSP, Ray S, Shastri P, Rao BK. Gastric tube placement in difficult cases: an extensive review of the alternate methods: The Indian Anaesthetists’ Forum October. 2008 2. Online ISSN 0973-0311
  • 11 Yamauchi M, Furuse S, Asano M, Watanabe M, Iwasaki S, Namiki A. Insertion of a nasogastric tube with the patient in the prone position. Can J Anaesth 2005; 52 (10) 1106-1107
  • 12 Ghatak T, Samanta S, Baronia AK. A new technique to insert nasogastric tube in an unconscious intubated patient. N Am J Med Sci 2013; 5 (01) 68-70
  • 13 Sahu S, Kishore K, Sachan V. Chatterjee A. Rare complication of nasogastric tube knotting around endotracheal tube in an anesthetized patient undergoing surgery. Anesth Essays Res 2017; 11 (01) 248-250
  • 14 Ozer S, Benumof JL. Oro-and nasogastric tube passage in intubated patients: fiberoptic description of where they go and how to make them enter the esophagus. Anesthesiology 1999; 91 (01) 137-143
  • 15 Lind LJ, Wallace DH. Submucosal passage of a nasogastric tube complicating attempted intubation during anesthesia. Anesthesiology 1978; 49 (02) 145-147