In medicine, a fistula (pl. fistulas or fistulae) is an abnormal connection or passageway between organs or vessels that normally do not connect.
Location of fistulas
Fistulas can develop in various parts of the body. The following information primarilly addresses the types of fistula diseases that can develop in the gastrointestinal tract (as well as the genitourinary system):
Diseases of the digestive and genitourinary systems
- Fistula of salivary gland
- Fistula of stomach and duodenum
- Gastrocolic fistula
- Gastrojejunocolic fistula
- Enterocutaneous fistula : between the intestine and the skin surface, namely from the duodenum or the jejunum or the ileum. This definition excludes the fistulas arising from the colon or the appendix.
- Gastric fistula : from the stomach to the skin surface
- Fistula of appendix
- Anal fistula
- Anorectal fistula: connecting the rectum or other anorectal area to the skin surface. This results in abnormal discharge of feces through an opening other than the anus. Also called fistula-in-ano.
- Fecal fistula : see Anorectal
- Fistula-in-ano : see Anorectal
- Rectal fistula
- Anorectal fistula
- Fistula of intestine
- Enteroenteral fistula : between two parts of the intestine
- Fistula of gallbladder
- Fistula of bile duct
- Biliary fistula : connecting the bile ducts to the skin surface, often caused by gallbladder surgery
- Pancreatic fistula: between the pancreas and the exterior via the abdominal wall
- Vesicointestinal fistula
- Urethral fistula
- Innora :between the prostatic utricle and the outside of the body
- Fistula of nipple
- Fistulae involving female genital tract / Obstetric fistula
- Vesicovaginal fistula: between the bladder and the vagina
- Other female urinary-genital tract fistulae
- Cervical fistula : abnormal opening in the cervix
- Fistula of vagina to small intestine
- Enterovaginal fistula : between the intestine and the vagina
- Fistula of vagina to large intestine
- Rectovaginal: between the rectum and the vagina
- Other female intestinal-genital tract fistulae
- Female genital tract-skin fistulae
- Other female genital tract fistulae
- Female genital tract fistula , unspecified
Types of fistulas
Various types of fistulas include:
- Blind : with only one open end
- Complete : with both external and internal openings
- Incomplete : a fistula with an external skin opening, which does not connect to any internal organ
Although most fistulas are in forms of a tube, some can also have multiple branches.
Various causes of fistula are:
- Diseases : Inflammatory bowel diseases, such as Crohn's disease and ulcerative colitis, are the leading causes of anorectal, enteroenteral, and enterocutaneous fistulas. A person with severe stage-3 hidradenitis suppurativa will also develop fistulas.
- Medical treatment : Complications from gallbladder surgery can lead to biliary fistula. Radiation therapy can lead to vesicovaginal fistula.
- Trauma : Head trauma can lead to perilymph fistulas, whereas trauma to other parts of the body can cause arteriovenous fistulas. Obstructed labor can lead to vesicovaginal and rectovaginal fistulas. Vesicovaginal and rectovaginal fistulas may also be caused by rape, in particular gang rape, as evidenced by the abnormally high number of women in conflict areas, such as that of the Second Congo War, who have suffered fistulae.
Treatment for fistulae varies depending on the cause and extent of the fistula, but often involves surgical intervention combined with antibiotic therapy.
Typically the first step in treating a fistula is an examination by a doctor to determine the extent and "path" that the fistula takes through the tissue.
Surgery is often required to assure adequate drainage of the fistula (so that pus may escape without forming an abscess). Various surgical procedures are commonly used, most commonly fistulotomy, placement of a seton (a cord that is passed through the path of the fistula to keep it open for draining), or an endorectal flap procedure (where healthy tissue is pulled over the internal side of the fistula to keep feces or other material from reinfecting the channel). Surgery for anorectal fistulae is not without side effects, including recurrence, reinfection, and incontinence.
It is important to note that surgical treatment of a fistula without diagnosis or management of the underlying condition, if any, is not recommended. For example, surgical treatment of fistulae in Crohn's disease can be effective, but if the Crohn's disease itself is not treated, the rate of recurrence of fistula is very high (well above 50%).
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