Incapacitating Mediastinal Pain and Hemodynamic Compromise Due to a Non-Displaced, Acutely Kinked Nasogastric Tube in a Post-operative Esophagectomy Patient – A Case Report

Introduction: A case of incapacitating mediastinal stretch pain and hemodynamic compromise, caused by a non-displaced, non-functional acutely kinked naso-gatsric tube (NGT). Post-operative esophagectomy patient started complaining of severe retrosternal pain after 2 h. Epidural boluses of bupivacaine and other intravenous analgesics were given with no relief. After some time, the patient went into atrial fibrillation and subsequent hypotension. Chest X-ray revealed mediastinal shadow caused by distended neoesophagus, and NGT was found to be acutely kinked, which prevented complete decompression of esophagus. Expanded neoesophagus caused a mass effect irritating the right atrium and causing atrial fibrillation, while stretching of nociceptive rich mediastinal structures led to persistent severe pain. NGT was manipulated, in an attempt to resolve the kink and although the kink could not be removed completely, it smoothened out enough to deflate the expanded neoesophagus. The pain subsided within 45 min of the NGT manipulation. Electrocardiography pattern also reverted to sinus rhythm within 24 h. Keywords: Hemodynamic compromise, Esophagectomy, Kinked Nasogastric tube, Mediastinal pain