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Endotracheal tube retained in stomach

1 January 2002

A cholecystectomy was carried out privately on a middle-aged man with known alcoholism and he made an apparently full recovery.

Four years later he had a haematemesis and was admitted to an NHS district general hospital and endoscoped. The physician found active bleeding from oesophageal varices which were injected. A Sengstaken tube was passed to prevent further haemorrhage and was removed four days later.

A repeat endoscopy was carried out six weeks later for additional injections, and to assess the stomach and duodenum without the handicap of active bleeding. Both were normal, but the physician noted a foreign body embedded in the wall of the stomach. He could not identify or dislodge it at that time, or at a second endoscopy a month afterwards. A portex tube nearly 30cm long was subsequently removed at laparotomy; it had been firmly adherent to the gastric wall and was covered in scaly accretions.

The patient made a claim against the health authority in the misplaced belief that the tube had been left behind after the initial gastroscopy. Subsequent investigation and comparison of serial numbers showed that this could not have been so and threw suspicion on the private operation seven years previously. It transpired that at that time the anaesthetist had had some difficulty in emptying the patient's stomach and he had only achieved it by using an uncut plain endotracheal tube passed into the stomach. A conventional nasogastric tube was then passed through the lumen. This was removed at the end of the operation, but the endotracheal tube in the oesophagus was left behind.

It was of course negligent to leave the tube in the patient, and the MDU's liability on behalf of the private anaesthetist was clear. Considerable argument on causation ensued, as the patient's solicitors alleged that many of the symptoms and signs attributable to his known alcoholism were in fact a result of the four year presence of the offending tube. The case put forward by the MDU's advisers held sway in the end however and the claim was settled for £2,500 on the private anaesthetist's behalf.

This guidance was correct at publication on 01/01/2002. It is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.

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