Fistula

Fistulas can develop in various parts of the body. The following list is sorted by the International Statistical Classification of Diseases and Related Health Problems.

K: Diseases of the digestive system

Duodeno Biliary Fistula

• (K11.4) Salivary gland fistula
• (K31.6) Fistula of stomach and duodenum
• (K31.6) Gastrocolic fistula
• (K31.6) Gastrojejunocolic fistula – after a Billroth II a fistula forms between the transverse colon and the upper jejunum (which, post Billroth II, is attached to the remainder of the stomach). Fecal matter passes improperly from the colon to the stomach and causes halitosis.
  • 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
• (K38.3) Fistula of appendix
• (K60) Anal and rectal fissures and fistulas
  • (K60.3) Anal fistula
  • (K60.5) Anorectal fistula (fecal fistula, fistula-in-ano): 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.
• (K63.2) Fistula of intestine
  • Enteroenteral fistula: between two parts of the intestine
• (K82.3) Fistula of gallbladder
• (K83.3) 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

Various types of fistulas include:

• Blind: Only one open end; may also be called sinus tracts
• Complete: Both internal and external openings
• Incomplete: An external skin opening that 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 fistulas include:

• Disease: Inflammatory bowel disease, more often in the form of Crohn's disease than ulcerative colitis,[6] is the leading cause 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 fistulas. Radiation therapy can lead to vesicovaginal fistulas. Arteriovenous fistulas can be created deliberately.
• 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. An obstetric fistula develops when blood supply to the tissues of the vagina and the bladder (and/or rectum) is cut off during prolonged obstructed labor. The tissues die and a hole forms through which urine and/or feces pass uncontrollably. Vesicovaginal and rectovaginal fistulas may also be caused by rape, in particular gang rape, and rape with foreign objects, as evidenced by the abnormally high number of women in conflict areas who have suffered fistulae.[7][8] In 2003, thousands of women in eastern Congo presented themselves for treatment of traumatic fistulas caused by systematic, violent gang rape, often also with sharp objects that occurred during the country's five years of war. So many cases have been reported that the destruction of the vagina is considered a war injury and recorded by doctors as a crime of combat.[9]

Treatment for fistula 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.

In some cases the fistula is temporarily covered, for example a fistula caused by cleft palate is often treated with a palatal obturator to delay the need for surgery to a more appropriate age.

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). Treatment involves filling the fistula with fibrin glue; also plugging it with plugs made of porcine small intestine submucosa have also been explored in recent years, with variable success. Surgery for anorectal fistulae is not without side effects, including recurrence, reinfection, and incontinence. A high rate of recurrence and more chances of complications like incontinence are always there in fistula surgeries (Anal Fistula).

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 the fistula is very high (well above 50%).

There is a unique and superior treatment using fibrin glue to close the anal fistulas that take cares of patient comfort, an undisturbed sphincter function, reduced hospital stay, reduced the need of the postoperative analgesia and minimized operative trauma, wound pain, complications and adverse reactions. This minimal invasive procedure helps quick recovery of patients in order to continue their normal daily activities.[10]

In people with kidney failure, requiring dialysis, a cimino fistula is often deliberately created in the arm by means of a short day surgery in order to permit easier withdrawal of blood for hemodialysis.

As a radical treatment for portal hypertension, surgical creation of a portacaval fistula produces an anastomosis between the hepatic portal vein and the inferior vena cava across the omental foramen (of Winslow). This spares the portal venous system from high pressure which can cause esophageal varices, caput medusae, and hemorrhoids.

• Obstetric fistula
• Stoma (medicine)
• Alexis St. Martin