An abnormal passage that leaks the contents of the stomach or the intestine (small or large bowel) to other organs, usually other parts of the intestine (entero-enteral) or the skin (enterocutaneous).
Causes, incidence, and risk factors
The majority of entero-enteral or enterocutaneous fistulas are the result of surgery. A significant minority result from trauma, especially penetrating traumas such as stab wounds or gunshot wounds. Inflammatory processes, such as infection or inflammatory bowel disease (Crohn's disease), may also cause fistulas.
Signs and tests
A contrast swallow study, in which a radio-opaque dye is swallowed by the patient and X-rays taken, often delineates the anatomy of the fistula. If the fistula involves the colon, a contrast enema, where the contrast dye is given via the rectum, may be useful. A CT scan of the abdomen is usually obtained to determine if an abscess, or walled-off pocket of infection, is associated with the fistula. A "fistulogram," in which radio-opaque dye is injected into the opening of the skin of an enterocutaneous fistula and X-rays taken, is often performed as well.
Treatment
Most fistulas will close on their own after a period of weeks to months. Depending on the clinical situation, patients may require IV nutrition and a period of time without food to allow the fistula time to close. In some cases, surgery is necessary to remove the segment of intestine involved in a non-healing fistula.
Expectations (prognosis)
The prognosis varies depending on the cause and severity of the fistula and the overall condition of the patient. In most cases, the prognosis is excellent in an otherwise healthy patient.
Complications
Fistulas can result in malnutrition and dehydration depending on their location in the intestine. They can also be a source of skin problems and infection.
Calling your health care provider
Call your health care provider if you have a significant change in bowel habits, especially severe diarrhea, or if you have any leakage of fluid this seems to come from the intestines or stomach from anywhere on the skin, particularly if you have recently had abdominal surgery.