title: Gastric perforation in an adult male following nasogastric intubation.
abstract: BACKGROUND
  Spontaneous gastric perforation is a well known surgical emergency which carries significant mortality and morbidity. Well documented causes in adults include peptic ulcer disease, drugs such as non-steroidal and gastric malignancy. Iatrogenic causes still remain relatively  rare. We report an interesting case of an acutely unwell young man who developed gastric perforation secondary to nasogastric intubation.
  
  
  METHODS
  A 32 year old man initially treated for gastroenteritis underwent laparotomy for acute intra-abdominal bleeding. This was found to be secondary  to a ruptured left hepatic artery aneurysm which was subsequently embolised. Patient had multiple laparotomies, a nasogastric tube inserted at the second laparotomy was later found to be the cause of gastric perforation. On further investigation the patient's multiple aneurysms were histologically  confirmed to be secondary to fibromuscular dysplasia (FMD).
  
  
  CONCLUSIONS
  We present here a case of gastric perforation from a nasogastric tube in an adult male and discussed its relevance to the diagnosis of FMD. This case highlights the importance of having a high index of suspicion for  this complication when managing patients with severe abdominal sepsis.
authors.affiliation: Sherwood Forest Hospitals NHS Foundation Trust, UK.
authors.forename: P
authors.initials: P
authors.lastname: Daliya
authors.forename: T J
authors.initials: TJ
authors.lastname: White
authors.forename: K R
authors.initials: KR
authors.lastname: Makhdoomi
mesh_terms: D034841:Abdominal Cavity; D000328:Adult; D017542:Aneurysm, Ruptured / Q000601:surgery*; D006470:Hemorrhage / Q000209:etiology; D006499:Hepatic Artery / Q000601:surgery; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000009:adverse effects*; D008297:Male; D013270:Stomach / Q000293:injuries* / Q000601:surgery