Non-pouching options for fistulas are indicated for which condition?

• A. <100 cc/24 hrs, preferably <45 cc/24 hrs
• B. High output (>100 cc/24 hrs)
• C. Fistulas with no effluent
• D. Any fistula regardless of output

Answer: (A)

Non-pouching options are chosen when fistula drainage is minimal, because only small volumes reach the skin and can be managed without a collecting bag. With very low output—typically less than about 100 mL in 24 hours, and ideally under 45 mL in 24 hours—the skin barrier and simple absorbent dressings can protect the skin, reduce leakage, and favor healing without the bulk and maintenance of a pouch. When output is higher, a pouching system is usually needed to collect effluent and prevent skin damage, making non-pouching inappropriate. A fistula with no effluent doesn’t require a pouch, while treating any fistula regardless of output with a non-pouching approach would risk skin breakdown if drainage increases.