Purple skin discoloration with dilated, tortuous veins on the stoma is indicative of what?

• A. Mucocutaneous separation
• B. Granulomas
• C. Peristomal varices
• D. Stoma prolapse

Answer: (C)

Peristomal varices arise when portal hypertension drives collateral venous flow to the abdominal wall around a stoma. The purple skin discoloration with dilated, tortuous veins is a vascular pattern created by these enlarged collateral veins, which is the hallmark of peristomal varices. This appearance is distinct from mucocutaneous separation (tissue detachment at the stoma edge), granulomas (nodular inflammatory tissue), or stoma prolapse (the stoma itself protruding). Peristomal varices signal venous dilation due to underlying portal hypertension and carry a risk of significant bleeding, so they prompt evaluation and management of the underlying portal pressure along with local hemostatic and supportive care.