Esophageal obstruction secondary to enteral nutrition via nasogastric tube in moderate traumatic brain injury: A case report and literature review.

RATIONALE: Enteral nutrition via nasogastric (NG) tube is a standard intervention in intensive care units, particularly for patients with moderate traumatic brain injury (TBI). While effective, this approach may be associated with complications such as aspiration or feeding intolerance. However, esophageal bezoar formation remains an extremely rare complication.

PATIENT CONCERNS: We report a case involving a 50-year-old male with moderate TBI who underwent emergent craniotomy and decompressive craniectomy following intracranial hematoma. Postoperatively, the patient was managed in the intensive care unit with invasive mechanical ventilation and NG tube - administered enteral nutrition. On day 18 of enteral feeding, he developed acute esophageal obstruction.

DIAGNOSES: Computed tomography and esophagogastroduodenoscopy confirmed a bezoar in the mid-to-upper esophagus composed of solidified enteral formula.

INTERVENTIONS: In vitro solubility testing identified 5% sodium bicarbonate as the most effective dissolution agent. Under endoscopic guidance, serial administration and aspiration of sodium bicarbonate successfully resolved the obstruction.

OUTCOMES: Follow-up confirmed restoration of esophageal patency, and the patient recovered swallowing function prior to discharge.

LESSONS: This case underscores a rare but clinically significant complication of NG tube feeding in patients with moderate TBI. Prompt recognition, endoscopic confirmation, and tailored chemical dissolution therapy are essential for resolution. Preventive strategies, such as early consideration of post-pyloric feeding and careful monitoring of tube function, are warranted in high-risk populations.