A Rare Case of Pneumobilia and Pancreatitis Following Difficult IRIS-Guided Nasoenteric Tube Placement With Additional Air Insufflation: A Case Report and Literature Review.

This article presents a rare case of acute pancreatitis and pneumobilia identified after difficult Kangaroo feeding tube with Integrated Real-time Imaging System (IRIS) Technology insertion in a 40-year-old female with multiple comorbidities. The patient's profound cardiogenic shock, recently initiated captopril, and imaging evidence of descending and sigmoid colitis suggested a likely multifactorial process that may also have included ischemic pancreatic and bowel injury. Although a temporal association with additional air insufflation was noted, the exact causal relationship remains uncertain, with a procedure-related contribution considered more plausible for pneumobilia than for pancreatitis. To our knowledge, no similar published case was identified. The article highlights the possible etiologies of these complications after NG tube insertion and emphasizes the need for careful insufflation practices and thoughtful deployment of advanced NG tube technologies in critically ill patients.