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- Catastrophic Outcome: Feeding Tube Placement Leads to Fatal Brain Injury in Anesthetized Persian Cat
Catastrophic Outcome: Feeding Tube Placement Leads to Fatal Brain Injury in Anesthetized Persian Cat
Journal of Veterinary Emergency and Critical Care 2025
Obi Veterinary Education
September 07, 2025
Federico Gianolli, Lea Carisch, Katrin Melanie Beckmann, Annette Patricia Nora Kutter, Meike Hammer
Background
Nasogastric tubes (NGTs) are commonly used in human and veterinary medicine for gastric decompression and nutritional support, often inserted without visual guidance. While complications from NGT placement are known, including epistaxis and pneumothorax, accidental intracranial insertion is rare and previously undocumented in veterinary literature. This report presents the first case of nasoenteric tube insertion into the brain of a cat.
Methods
A 7-year-old spayed female Persian cat was admitted with acute decompensation of chronic hepatobiliary disease, including biliary obstruction. Emergency cholecystectomy was performed under general anesthesia. During the procedure, a 5-French polyurethane NGT with a stylet was inserted blindly through the right nostril while the cat remained anesthetized and in dorsal recumbency. Following unexpected apnea and failure to regain consciousness, MRI imaging was performed.
Results
MRI revealed that the NGT had penetrated the cribriform plate and entered the brain, causing hemorrhage and edema throughout the thalamus, mesencephalon, and ventricles. Necropsy confirmed acute cribriform plate perforation and brain trauma consistent with the tube’s trajectory. Despite supportive care, the cat remained comatose with abnormal respiration and was euthanized due to a grave prognosis.
Limitations
This single-case report cannot determine causality or risk prevalence. Retrospective analysis could not definitively assess whether alternate positioning, tube size, or confirmation techniques would have prevented the incident. Subjective assessment of aspirated fluid as "gastric" may have contributed to delayed recognition of misplacement.
Conclusions
This case illustrates a rare but catastrophic risk of NGT insertion in brachycephalic, anesthetized cats. Severe skull conformation abnormalities likely predisposed the cat to cribriform plate perforation. The authors recommend the use of radiographic confirmation prior to full insertion, avoidance of stylets in high-risk patients, and heightened caution with brachycephalic breeds under anesthesia. Institutional practices are being revised to prevent recurrence.
MRI images of a brachycephalic Persian cat following inadvertent insertion of a tube intended for nasogastric feeding into the brain; the tube has been removed. (G, H) Dorsal and paramedian T1-weighted MR image of the skull. White lines indicate the course of the tube through the cribriform plate and brain. Magnetic resonance images are displayed in radiologic convention (i.e., the right side of the cat is to the left of the image, and rostral is to the left of the image).
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