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July 18, 1977

Knotted Nasogastric Tubing

JAMA. 1977;238(3):211-212. doi:10.1001/jama.1977.03280030019007

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To the Editor.—  In a recent letter (237:1432, 1977), Morris reported an unusual complication of nasogastric intubation: knotting of the tube within the stomach with resultant traumatic withdrawal through the nose.While an intern, I discovered a patient's Miller-Abbott tube could not be withdrawn even through the esophagogastric junction because of a large and complex knot. After prolonged and painful manipulation under fluoroscopy, surgical consultation seemed necessary when a radiology consultant and I devised a successful technique to unknot the tube: the stomach was filled with water just to the point of discomfort, and the knot was allowed to float freely within the dilated organ. Within minutes the knot untied itself and the tube was easily withdrawn.Several years later by chance I came on a frustrated radiologist unsuccessfully attempting to untie a plain nasogastric tube knotted within a patient's stomach. We distended the stomach with water, and once again,