What causes a brown or bloody substance to come out of a dislodged Gastrojejunostomy (GJ) tube?

From the Guidelines

A brown or bloody substance coming out of a dislodged Gastrojejunostomy (GJ) tube is typically caused by gastric or intestinal contents mixed with blood from tissue trauma during the dislodgement, as evidenced by the most recent guidelines 1. This discharge occurs because the GJ tube creates a direct connection between the stomach or small intestine and the outside of the body, allowing internal contents to leak when the tube is displaced. The brown color usually indicates a mixture of digestive fluids, partially digested food, and possibly bile, while the bloody component results from damage to the surrounding tissue when the tube shifts from its proper position. The bleeding typically comes from irritation or tearing of the stoma site or internal mucosal tissue. Some key points to consider in managing this situation include:

• Covering the stoma site with a clean dressing to prevent infection
• Not attempting to reinsert the tube yourself to avoid further complications
• Seeking immediate medical attention for proper replacement of the tube by a healthcare professional
• Being aware of the risk factors for peristomal leakage, such as skin infection, increased gastric acid secretion, and patient-related factors like diabetes and immunosuppression, as highlighted in recent studies 1
• Understanding that the longer the tube remains dislodged, the greater the risk of the stoma closing or becoming infected, potentially requiring surgical intervention for replacement, as noted in the guidelines 1.

From the Research

Causes of Brown or Bloody Substance from a Dislodged GJ Tube

• A dislodged Gastrojejunostomy (GJ) tube can cause a range of complications, including the presence of a brown or bloody substance coming out of the tube 2.
• The exact cause of this substance is not explicitly stated in the provided studies, but it can be inferred that it may be related to the tube's displacement or malfunction 3, 2.
• GJ tubes are commonly used to provide postpyloric enteral nutrition, and their dislodgement can lead to various issues, including tube displacement, clogging, or cracking 4, 3.
• In some cases, the substance may be a result of the tube's interaction with the gastrointestinal tract, such as gastric outlet obstruction or aspiration pneumonia 2.
• It is essential to note that GJ tubes are not without risks, and their management requires careful attention to prevent and manage common complications 5.

Common Complications Associated with GJ Tubes

• Tube displacement or dislodgement is a common complication associated with GJ tubes, which can lead to various issues, including the presence of a brown or bloody substance 3, 2.
• Other common complications include clogged tubes, cracked tubes, or ruptured balloons 3.
• GJ tubes may not be the most feasible clinical option for providing long-term enteral access in children intolerant to gastrostomy tube feeds 3.
• The management of GJ tubes requires careful attention to prevent and manage common complications, and healthcare providers play an active role in supporting patients and parents/caregivers in dealing with these complications 5.