Which sign may indicate a peristomal fistula during examination?

• A. Adherence of the pouching system may be the first sign.
• B. Decreased stoma output.
• C. There is no drainage around the stoma.
• D. Skin around the stoma remains unaffected.

Answer: (A)

A peristomal fistula allows intestinal contents to leak around the stoma and into the peristomal skin. The first clue clinicians often notice is the pouching system adhering to the skin around the stoma. This happens because leakage from the fistula can seep under the barrier, making the adhesive area tacky and causing the pouching system to stick to the peristomal area. This early sign can appear before more obvious drainage or skin damage is seen, so adhesion of the pouching system is a practical cue to inspect further for a fistula. By contrast, decreased stoma output isn’t a reliable early sign of a peristomal fistula, and no drainage around the stoma or skin that remains unaffected would argue against one.