Case Reports: Case Report
As anesthesiologists, we can all recall interesting cases. Most of them are preserved as oral history shared between colleagues (and often residents), to illustrate important learning points. Commonly, the most interesting cases are instances of a near-miss situation, when a disaster was averted. However, what elevates such tales to become publication-worthy? In other words, what constitutes a reportable case? Often, it is a case that runs contrary to current teaching and forces us to reconsider doctrine.1 Or a publishable case report may describe the rare disease or comorbidity that cannot be found commonly in our literature.2,3 Last, a good case report may demonstrate quick thinking by an anesthesiologist to prevent a bad outcome.4
But a misadventure during the placement of an intraoperative orogastric tube (an OG tube!), how can that be a publishable case report? No, this report does not include an image of an intracranial nasogastric tube, because that has been published before.5 So an OG tube is placed, bleeding occurs, yada, yada, yada. Our readers will probably think, “A simple procedure gone wrong and they get a case report? I could do that.” Obviously, this must be a case report about nothing. Or is it?
In this issue of A & A Case Reports, Turabi et al.6 describe a case of esophageal perforation after intraoperative placement of an OG tube. But what makes this case compelling is the complete description of the intraoperative and postoperative management of this patient. One could easily understand how blood in an OG tube after removal, without subsequent rebleeding, could be just dismissed as a minor trauma and ignored. If this type of thinking had been followed, the complication that occurred in the postanesthesia care unit probably would have been missed, delaying care. But by thinking about the patient while still in the operating room, obtaining an urgent otolaryngology consult, examining the patient while still anesthetized, the care team was able to learn something important about the patient before tracheal extubation and transfer to the postanesthesia care unit. Ultimately, this new and unexpected clinical information discovered intraoperatively allowed for immediate and appropriate actions to be taken, thus avoiding a possible disastrous outcome.
This case does not challenge doctrine or describe a rare disease; however, it does demonstrate something equally important: the benefit of thorough evaluation of a patient, our patient, and that is publication-worthy. So a case report about nothing? You be the judge.
Timothy Angelotti, MD, PhD
Department of Anesthesia
1. Fischer SP, Schmiesing CA, Guta CG, Brock-Utne JG. General anesthesia and chronic amphetamine use: should the drug be stopped preoperatively? Anesth Analg. 2006;103:203–6
2. Ratner EF, Hamilton CL. Anesthesia for cesarean section in a pituitary dwarf. Anesthesiology. 1998;89:253–4
3. Angelotti T, Mireles S, McMahon D. Anesthetic implications of a near-lethal sodium azide exposure. Anesth Analg. 2007;104:229–30
4. Tsui BC, Malherbe S, Koller J, Aronyk K. Reversal of an unintentional spinal anesthetic by cerebrospinal lavage. Anesth Analg. 2004;98:434–6
5. Genú PR, de Oliveira DM, Vasconcellos RJ, Nogueira RV, Vasconcelos BC. Inadvertent intracranial placement of a nasogastric tube in a patient with severe craniofacial trauma: a case report. J Oral Maxillofac Surg. 2004;62:1435–8
6. Turabi AA, Urton RJ, Anton TM, Herrman R, Kwiatkowski D. Esophageal perforation and pneumothorax after routine intraoperative orogastric tube placement. A & A Case Reports. 2014;2:122–4