title: Gastric perforation after accidental esophageal intubation in a patient with deep neck infection.
abstract: Deep neck infection with airway obstruction may complicate endotracheal intubation with limited neck motion, pharyngeal swelling, and prominent secretion. Unrecognized esophageal intubation (EI) may unduly overinflate the stomach to inhibit effective ventilation, increase the incidence of hypoxia, and produce a ruptured visceral organ. We report an 81-year-old female patient with deep neck infection and impending respiratory failure who suffered gastric perforation after accidental EI in the intensive care unit. After failed attempts of intubation, EI was recognized rapidly as the culprit, although roughly audible bilateral breathing sounds were present but not gastric bubble sounds. A catastrophic complication of gastric rupture occurred due to ambu-bagging and mechanical ventilation. Surgical intervention was performed immediately. Possible mechanisms are discussed.
authors.affiliation: Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan.
authors.forename: Po-Nien
authors.initials: PN
authors.lastname: Chen
authors.affiliation: Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan.
authors.forename: Chih-Kai
authors.initials: CK
authors.lastname: Shih
authors.affiliation: Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan.
authors.forename: Ya-Hui
authors.initials: YH
authors.lastname: Li
authors.affiliation: Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan.
authors.forename: Wei-Ching
authors.initials: WC
authors.lastname: Cheng
authors.affiliation: Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan; Department of Anesthesiology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan.
authors.forename: Hung-Te
authors.initials: HT
authors.lastname: Hsu
authors.affiliation: Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan; Department of Anesthesiology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan. Electronic address: 770234anesthesia@gmail.com.
authors.forename: Kuang-I
authors.initials: KI
authors.lastname: Cheng
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001424:Bacterial Infections / Q000150:complications; D004947:Esophagus; D005260:Female; D006801:Humans; D007440:Intubation / Q000009:adverse effects*; D009333:Neck; D013270:Stomach / Q000293:injuries*
keywords: intubation: esophageal; soft tissue infections: deep neck; stomach rupture