May 4, 2016 | Josh Farkas
The most widely feared complication of placing a Blakemore tube is complete inflation of the gastric balloon while it is not in the stomach. If the gastric balloon is fully inflated anywhere outside the stomach (i.e. esophagus, trachea, bronchus, duodenum), this may cause visceral perforation.
Two cases of ultrasound-guided Blakemore placement
A patient required Blakemore tube placement due to refractory variceal hemorrhage. With continuous monitoring via transgastric ultrasonography, the Blakemore tube was advanced. The tube could be visualized entering the stomach. When the tube was advanced to a depth of 50 cm, the gastric balloon was inflated with 50ml of air. The balloon was well visualized by ultrasonography to be inflating within the stomach.
Since ultrasonography is not a validated tool to confirm placement in the stomach, an abdominal X-ray was also ordered and waiting at the bedside. A portable X-ray was obtained, which confirmed that the balloon was inflated below the diaphragm.
Abdominal ultrasonography was resumed following the X-ray, but at that point the Blakemore tube could no longer be seen within the stomach. Further evaluation revealed that the tube had been inadvertently withdrawn while positioning the patient after the X-ray. The tube was re-advanced to 50cm, at which point the balloon could again be visualized within the stomach. At this point, the balloon was fully inflated under direct ultrasonographic guidance.
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