Fragmentation of Celestin tube: a cause of fatal intestinal perforation

A singular case is described in which a pateint with a Celestin endoesophageal tube in place for 10 months died of complications from small bowel perforation resulting from disruption of the tube. The lower part of the tube lying within the stomach had deteriorated and become detached except for a single strand of nylon monofilament. This fragment passed into the small intestine, where it remained tethered at the level of the distal jejunum, acting first as an obscure cause of intermittent small bowel obstruction and later as the cause of jejunal perforation. In the patient who is a candidate for esophageal intubation and who has a life expectancy beyond 6 or 8 months, consideration should be given to using a device other than the Celestin tube. Whenever a Celestin appliance is used to palliate dysphagia, the intragastric part of the tube should be anchored to the stomach with multiple sutures.