LAUSR

A 70-year-old woman was hospitalized with failure to thrive. Her recent history included bereavement and protein-calorie malnutrition. Her body mass index was 17 kg/m2. She was oriented only to person. Laboratory tests showed hypernatremia and prerenal azotemia. A nasogastric (NG) feeding tube was placed successfully on hospital day 3 (Fig. 1), and enteral feeding was commenced. The patient’s mental status improved to tolerate an oral diet with bedside removal of the tube on hospital day 11; however, a portion of the distal tubing was missing. An abdominal X-ray study showed 8 cm of retained tubing in the stomach (Fig. 2). An esophagogastroduodenoscopy (EGD) was performed with foreign body extraction using a rat-tooth forceps (Figs. 3 and 4). She was discharged the following day. One prior case report describes a fractured orogastric tube after intraoperative placement [1], while another reports nasojejunal tube fracture [2]. Our case describes spontaneous transection of NG tubing after successful placement and 8 days of enteral feeding, without resistance upon removal. The mechanism of transection is unclear. The American Society for Gastrointestinal Endoscopy recommends urgent endoscopy for objects > 6 cm above the proximal duodenum, which was performed in this case [3]. This recommendation