…

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Fistula

A fistula is an abnormal connection

between two hollow spaces (technically,
two epithelialized surfaces), such as
blood vessels, intestines, or other hollow
organs. Fistulas are usually caused by
injury or surgery, but they can also result
from an infection or inflammation.[3]
Fistulas are generally a disease
condition, but they may be surgically
created for therapeutic reasons.

Fistula

Abdominal CT scan with right

colocutaneous fistula and associated
subcutaneous pneumatosis.

Pronunciation /ˈfɪstjʊlə/[1][2]

Specialty General surgery

In botany, the term is most common in
its adjectival forms, where it is used in
binomial names to refer to species that
are distinguished by hollow or tubular
structures. Monarda fistulosa, for
example, has tubular flowers;[4]
Eutrochium fistulosum has a tubular
stem; Allium fistulosum has hollow or
tubular leaves, and Acacia seyal ssp.
fistula is the subspecies with hollow
spines.

Locations
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.

H: Diseases of the eye, adnexa,

ear, and mastoid process
…

(H04.6) Lacrimal fistula

(H05.81) Carotid cavernous fistula
(H70.1) Mastoid fistula
Craniosinus fistula: between the
intracranial space and a paranasal
sinus
(H83.1) Labyrinthine fistula
 Perilymph fistula: tear between the
membranes between the middle
and inner ears
Preauricular fistula
Preauricular fistula: usually on the
top of the cristae helicis of the
ears

I: Diseases of the circulatory

system
…

(I25.4) Coronary arteriovenous fistula,

acquired
(I28.0) Arteriovenous fistula of
pulmonary vessels
 Pulmonary arteriovenous fistula:
between an artery and vein of the
lungs, resulting in shunting of
blood. This results in improperly
oxygenated blood.
(I67.1) Cerebral arteriovenous fistula,
acquired
(I77.0) Arteriovenous fistula, acquired
(I77.2) Fistula of artery

J: Diseases of the respiratory

system
…

(J86.0) Pyothorax with fistula

(J95.0) Tracheoesophageal fistula,
between the trachea and the
 esophagus. This may be congenital or
acquired, for example as a
complication of a tracheostomy.

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

M: Diseases of the …
musculoskeletal system and
connective tissue

(M25.1) Fistula of joint

N: Diseases of the urogenital

system
…

(N32.1) Vesicointestinal fistula

(N36.0) Urethral fistula
Innora:between the prostatic
utricle and the outside of the body
(N64.0) Fistula of nipple
(N82) Fistulae involving female genital
tract / Obstetric fistula
(N82.0) Vesicovaginal fistula:
between the bladder and the
vagina
(N82.1) Other female urinary-
genital tract fistulae
Cervical fistula: abnormal
opening in the cervix
(N82.2) Fistula of vagina to small
intestine
Enterovaginal fistula: between
the intestine and the vagina
(N82.3) Fistula of vagina to large
intestine
Rectovaginal: between the
rectum and the vagina
 (N82.4) Other female intestinal-
genital tract fistulae
(N82.5) Female genital tract-skin
fistulae
(N82.8) Other female genital tract
fistulae
(N82.9) Female genital tract
fistula, unspecified

Q: Congenital malformations,
deformations and chromosomal …

abnormalities

(Q18.0) Sinus, fistula and cyst of

branchial cleft
 Congenital preauricular fistula: A
small pit in front of the ear. Also
known as an ear pit or preauricular
sinus.
(Q26.6) Portal vein-hepatic artery
fistula
(Q38.0) Congenital fistula of lip
(Q38.4) Congenital fistula of salivary
gland
(Q42.0) Congenital absence, atresia
and stenosis of rectum with fistula
(Q42.2) Congenital absence, atresia
and stenosis of anus with fistula
 (Q43.6) Congenital fistula of rectum
and anus
(Q51.7) Congenital fistulae between
uterus and digestive and urinary tracts
(Q52.2) Congenital rectovaginal fistula

T: External causes …

(T14.5) Traumatic arteriovenous fistula

(T81.8) Persistent postoperative fistula

Types
Various types of fistulas include:
Types
Name Definition

Blind with only one open end; blind fistulas may also be called sinus tracts

Complete with both external and internal openings

a fistula with an external skin opening, which does not connect to any internal
Incomplete
organ

Although most fistulas are in forms of a

tube, some can also have multiple
branches.

Causes
Various causes of fistula include:
Causes
Category Elaboration

Inflammatory bowel disease, more often in the form of Crohn's disease than
ulcerative colitis,[5] is the leading cause of anorectal, enteroenteral, and
Diseases
enterocutaneous fistulas. A person with severe stage-3 hidradenitis suppurativa
will also develop fistulas.

Complications from gallbladder surgery can lead to biliary fistula. Radiation

Medical
therapy can lead to vesicovaginal fistula. An arteriovenous fistula can be
treatment
deliberately created, as described below in therapeutic use.

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
Trauma
foreign objects, as evidenced by the abnormally high number of women in
conflict areas who have suffered fistulae.[6][7] In 2003, thousands of women in
eastern Congo presented themselves for treatment of traumatic fistula 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.[8]

Treatment
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.[9]

Therapeutic use
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.
Etymology
The Latin word fistula (plural fistulas or
fistulae /-li, -laɪ/) literally means tube or
pipe.

See also
Obstetric fistula
Stoma (medicine)
Alexis St. Martin

References
1. OED 2nd edition, 1989.
2. Entry "fistula" in Merriam-Webster
Online Dictionary .
3. MedlinePlus Encyclopedia Fistula
4. Identification of Monarda fistulosa
Archived 2016-03-04 at the
Wayback Machine subpage of
Discover Life , 2014.
5. https://inflammatoryboweldisease.n
et/symptoms/complications/fistula
/
6. "Stephanie Nolen, "Not Women
Anymore…" Ms. Magazine, Spring
2005" . Archived from the original
on 2017-01-20. Retrieved
2007-12-11.
7. UNFPA: United Nations Population
Fund. Press Release, 22 June 2006.
"More Funding Needed to Help
Victims of Sexual Violence"
8. Emily Wax, Washington Post Foreign
Service. Saturday, October 25, 2003;
Page A01 "A Brutal Legacy of Congo
War"
9. Shah S, Bawa A, Mishra A, Nar AS
(May 2013). "The Role of Fibrin Glue
in the Treatment of High and Low
Fistulas in Ano" . Journal of Clinical
and Diagnostic Research. 7 (5):
876–879.
 doi:10.7860/JCDR/2013/5387.2964
. PMC 3681059 . PMID 23814732 .

External links
Classification MeSH: D005402 D

External resources MedlinePlus:

002365

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