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Insertion of Ryles tube is a simple routine procedure. During its insertion, minor complications like trauma to nose, nasopharynx and oral cavity do happen from time to time. But as the Ryles tube is usually inserted blindly, potentially life threatening complications like inadvertent entry into trachea, cranial cavity and intravascular penetration have been reported. Folds and kinks may occur, but true knot of the Ryles tube, which we now report, is very rare.