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A year-old male with multiple previous abdominal operations presented to the emergency department ED with abdominal pain and vomiting. Computed tomography CT revealed a small bowel obstruction. The emergency physician ordered a nasogastric tube and the nurse placed a 14 French catheter. The nurse encountered resistance upon advancement to just before the target length based on her initial measurements. Upon attempting to remove the tube, she encountered significant resistance near the end of removal. The patient experienced severe pain and developed epistaxis. The ED physician was also unable to retrieve the tube, nor visualize it within the oropharynx.

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