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Video:What Is a Fistula?

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A fistula is defined as an abnormal connection between two tubes within the body, typically between one tube and the skin. Learn what to look out for and stay informed about your gastrointestinal health.See Transcript

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Transcript:What Is a Fistula?

What is a Fistula?

A fistula is defined as an abnormal connection between two tubes within the body, typically between one tube and the skin. They occur when a damaged tubular organ forms a connection to a healthy organ or an area next to it.

Symptoms & Causes

The underlying cause is often an inflammatory process such as Crohn’s disease or an infection.  Other causes include damage due to surgery or radiation, or a cancer.

Fistulas often happen when an abscess expands, breaks through, and drains through other areas.

The fistula may also drain a foul-smelling discharge. Symptoms of fistulas vary depending on the site, type, and severity.  Fistulas caused by infection can be accompanied by pain, fever, tenderness, itching, and generally feeling poorly.

Treatment

Treatment of the fistula sometimes requires immediate attention, without
regard to the underlying disease – one example is an entero-aortic fistula. 

Finally surgery is often necessary to remove the damaged bowel.

Types of Fistulas [associated with GI/IBD]

One of the most common types of fistula is a perianal fistula.  Perianal fistulas are often not just from glands to skin – they are from bowel/rectum to skin – thereby enterocutaneous. In this condition, small glands around the anus fill with pus and then drain out.  If the open in the area around the anus they are referred to as perianal. In some cases they can track further out to the area between anus and the genitals, known as the perineum.  In more severe cases they may drain further out into the genital area such as the scrotum or labia. In some cases a very small fistula in this area my be asymptomatic and require no treatment.

Enterocutaneous: In this type of fistula a communication occurs between the intestine and the skin. This type of fistula may be a complication of surgery. If the fistula is not infected or severely inflamed they may sometimes heal by putting the bowel at rest by withholding food and given a person intravenous nutrition, although more often surgery is required.

Entero-enteric or Enterocolic fistulas occur when a communication forms between two areas of the intestine usually between one part of the small intestine to another or between the small and large intestine. In many cases the patient may have no symptoms and the patient need only be observed. Many times however these types of fistula result in diarrhea and/or malnutrition as large areas of the intestine may be bypassed. Similar to other types of fistulas, the approach to fixing them include addressing  the of the problem by treating the underlying infection or inflammatory bowel disease and surgery to remove the diseased bowel.

Enterovaginal: This is a fistula that goes to the vagina. These are characterized by the passage of air or fecal material through the vagina.

Enterovesicular: This type of fistula goes from the intestine to the bladder. These fistulas may result in frequent urinary tract infections, or the passage of gas or fecal matter during urination. The approach to treatment is similar to that of entero-vaginal fistulas.

Diagnosis, Treatment & Repair

The presence of a fistula is often obvious.  Many times the diagnosis will require the use of some type of X-ray to identify and assess the extent of the problem.

Some of the more standard tests include a small bowel series or barium enema.  In these tests a person will either drink or have some administered in enema form a liquid, which will show up on an xray. Under the x-ray it may be possible to see the barium passing from the bowel through the fistula.  

Another technique is to do a  fistulagram.  In this radio-opaque liquid is injected directly into the fistula to see where it goes.  In recent years  CT or MRI scans have been increasingly used as they help see the fistulas in greater detail.

Repair is of these types of fistula may require creating an ostomy, when the bowel is brought out through an opening in the skin to divert the fecal material away from the area where the fistula is repaired, allowing it to heal. When an ostomy is created it is fitted with an appliance commonly known as an ostomy bag to collect the stool.  Once the fistula is healed the ostomy is later reversed allowing the person to go to the bathroom normally.

Having a fistula can often be an uncomfortable and unpleasant experience. Fortunately with proper care most fistulas can be healed.   In cases, such as Crohn’s disease, patients will need to take medications for an extended period to reduce the risk of recurrence.

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