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Gastrocutaneous Fistula Skin Protection — SCE Palliative Medicine MCQ

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ModerateGI SymptomsGastrocutaneous Fistula Skin ProtectionSCE Palliative Medicine

A 65-year-old man with advanced gastric cancer has developed a large gastrocutaneous fistula from his abdominal wound. It drains acidic gastric fluid, causing severe excoriation of the periwound skin. What is the most appropriate local protective measure?

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Correct answer: D — Use of a zinc oxide barrier paste plus a stoma-type pouching system to contain gastric drainage and protect surrounding skin

The correct answer is D. Managing a gastrocutaneous fistula with acidic drainage requires both a chemical barrier to protect periwound skin (zinc oxide paste) and an effluent-containment system (stoma pouch). This approach interrupts the damaging cycle of leakage and skin breakdown. Option E (air exposure) can worsen excoriation. Option B (hourly gauze) is inefficient and does not provide chemical or mechanical protection. Option A (hydrocolloid) can dissolve with gastric fluid and fail under corrosive conditions. Option C (alcohol prep) irritates and damages already excoriated skin further. Evidence on topical management of enterocutaneous fistulas supports use of barrier products and pouching systems as key components of wound care.

Reference: Topical Management of Enterocutaneous and Enteroatmospheric Fistulas: A Systematic Review (2020), and Enterocutaneous Fistula: Proven Strategies and Updates (2016), PubMed