An intestinal fistula is a medical condition characterized by an abnormal connection between a part of the gastrointestinal tract and the skin or another organ, leading to the leakage of stomach acid.
1. Key Notes About Intestinal Fistulas
Here are some important facts about intestinal fistulas:
This condition is often referred to as an enteric fistula or enterocutaneous fistula and is typically considered a medical emergency.
Intestinal fistulas can be classified based on their causes as follows:
Primary Fistula: Usually caused by a congenital defect that appears in infants, such as a connection between the small intestine and the navel.
Secondary Fistula: Often results from trauma, such as surgical procedures, childbirth, or chronic inflammation (e.g., inflammatory bowel disease).
Some fistulas may not cause noticeable symptoms, especially if they form between adjacent loops of the intestine. However, others can significantly affect the quality of life, such as those that secrete pus or feces between the rectum and the vagina or the skin surrounding the anus.
Certain types of intestinal fistulas can lead to severe health complications, such as:
Recurrent urinary tract infections from a fistula between the large intestine and bladder.
Electrolyte imbalances and digestive system dysfunction.
Life-threatening conditions, such as a fistula between the aorta and duodenum, which can cause severe bleeding.
Patients with external enteric fistulas may have an open skin area, allowing stomach acid and other contents to leak onto the skin, causing significant damage.
2. Types of Intestinal Fistulas
There are four main types of intestinal fistulas:
Complex Fistula: Features multiple channels affecting more than one organ.
External Fistula: Connects part of the gastrointestinal tract to the skin.
Extra-intestinal Fistula: Links a part of the intestine to another organ, such as the bladder.
Enteric Fistula: Involves a connection between two areas of the intestine.
Symptoms of Intestinal Fistulas
Key observations regarding symptoms include:
Intestinal fistulas can disrupt food movement through the intestines and cause fluid and electrolyte leakage, reducing their levels in the body.
Common symptoms include:
Abdominal pain.
Dehydration due to fluid loss.
Diarrhea.
Fever.
Malnutrition.
Increased heart rate.
Vomiting.
Patients with enterocutaneous fistulas may develop sepsis due to infections entering the body, presenting with:
Low blood pressure.
High fever.
Elevated heart rate.
Organ failure.
Causes and Risk Factors of Intestinal Fistulas
Important notes on the causes and risk factors include:
Surgical Procedures: 80%–90% of intestinal fistulas occur after abdominal surgeries.
A study involving over 1,000 abdominal surgery patients found a 5.5% incidence rate of fistulas, mostly occurring within a week post-surgery.
Additional risk factors include:
History of abdominal radiation.
Infections, such as diverticulitis.
Inflammatory bowel diseases, including Crohn’s disease.
Gastrointestinal ulcers.
Physical trauma to the abdomen.
Cancer or tumors in the lungs or esophagus, which may cause fistulas between the esophagus and airways.
Complications of Intestinal Fistulas
Intestinal fistulas can lead to various complications, including:
Recurrent infections.
Malnutrition.
Electrolyte and mineral imbalances.
Delayed wound healing.
Death, with mortality rates reaching up to 40%, emphasizing the need for immediate treatment.
Diagnosis of Intestinal Fistulas
Key aspects of diagnosis include:
Medical History: The physician will ask about the patient's medical history, especially past surgeries, including gynecological procedures.
Symptoms Assessment: The physician evaluates symptoms, their onset, and any factors that worsen or alleviate them.
Diagnostic Tests:
Imaging Studies: CT scans to locate and assess the size of the fistula.
Barium Study: The patient ingests barium before an X-ray. Signs of intestinal leakage confirm the presence of a fistula.
Fistulography: A dye is injected into the fistula to identify any blockages.
Treatment of Intestinal Fistulas
Treatment depends on the severity of the condition. Simple cases may resolve spontaneously, with colonic fistulas closing within 30–40 days and small intestinal fistulas within 40–50 days.
1. Surgical Treatment
Key notes on surgical interventions:
Surgery is often recommended to repair drainage areas.
This may involve specialized drains, negative-pressure wound therapy, or other treatments to allow the fistula to heal.
Negative-pressure therapy uses vacuum technology to increase blood flow to the area and remove excess fluids.
Surgeons may also use endoscopic techniques, involving thin, lighted instruments inserted through the rectum into the abdomen.
Clips or adhesives may be applied to seal the fistula.
2. Medications
Medications are usually administered alongside surgery to manage symptoms, including:
Total Parenteral Nutrition (TPN): Provides nutrients via a central intravenous (IV) line.
Medications to Reduce Digestive Fluids, such as:
Glycopyrrolate: Reduces saliva production.
Proton Pump Inhibitors: Decrease acid secretion.
Antidiarrheal Medications: Help manage diarrhea.
Prevention of Intestinal Fistulas
While there are no clear methods to prevent intestinal fistulas, minimizing risk factors may help reduce the likelihood of developing this condition.