Recurrent Nasogastric Tube Insertion Failure Due to Anterior Cervical Osteophyte: A Case Report

Abstract

Nasogastric tube (NGT) insertion is a routine bedside procedure for enteral feeding, medication administration, and gastric decompression. While typically straightforward, repeated failures should prompt evaluation for structural causes. Anterior cervical osteophytes (ACOs), though often asymptomatic, can obstruct NGT passage and contribute to dysphagia or airway compromise. This case report describes recurrent NGT insertion failure caused by a prominent anterior cervical osteophyte at the C3–C4 level and emphasizes the importance of early structural assessment, particularly in patients with complex or overlapping clinical conditions. A 64-year-old man with recent medullary infarct and aspiration pneumonia presented with dysphagia and choking. After three failed NGT insertion attempts, flexible nasopharyngolaryngoscopy revealed posterior pharyngeal wall bulging and saliva pooling. Cervical spine radiography demonstrated a large anterior osteophyte at C3–C4 protruding into the hypopharynx. Multiple endoscopy-guided attempts were unsuccessful, but NGT placement was later achieved via esophagogastroduodenoscopy (OGDS), allowing safe establishment of enteral access. Structural abnormalities such as ACOs may be overlooked in patients with neurogenic dysphagia, therefore, endoscopic and radiologic evaluations are essential when repeated NGT failures occur. Early recognition and a multidisciplinary approach support safe and effective management, reducing the risk of procedural trauma and ensuring timely nutritional support.