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Fistula
Classification and external resources
MeSH D005402

In medicine, a fistula (pl. fistulas or fistulae) is an abnormal connection or passageway between two epithelium-lined organs or vessels that normally do not connect. It is generally a disease condition, but a fistula may be surgically created for therapeutic reasons.

Contents

Location of fistulas

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

I: Diseases of the circulatory system

J: Diseases of the respiratory system

K: Diseases of the digestive system

Duodeno Biliary Fistula

M: Diseases of the musculoskeletal system and connective tissue

  • (M25.1) Fistula of joint

N: Diseases of the urogenital system

Q: Congenital malformations, deformations and chromosomal abnormalities

T: External causes

  • (T14.5) Traumatic arteriovenous fistula
  • (T81.8) Persistent postoperative fistula

Types of fistulas

Various types of fistulas include:

  • Blind: with only one open end
  • Complete: with both external and internal openings
  • Incomplete: a fistula with an external skin opening, which does not connect to any internal organ

Although most fistulas are in forms of a tube, some can also have multiple branches.

Causes

Various causes of fistula are:

  • Medical treatment: Complications from gallbladder surgery can lead to biliary fistula. Radiation therapy can lead to vesicovaginal fistula. An arteriovenous fistula can be deliberately created, as described below in therapeutic use.
  • 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.[1][2] In 2003, thousands of women in eastern Congo presented themselves for treatment of traumatic fistula caused by systematic, violent gang rape 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.[3]

Treatment

Treatment for fistulae 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). Treatments involving filling the fistula with fibrin glue or 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.

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 fistula is very high (well above 50%).

Therapeutic use

In end stage renal failure patients, 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.

References

External links


1911 encyclopedia

Up to date as of January 14, 2010

From LoveToKnow 1911

Medical warning!
This article is from the 1911 Encyclopaedia Britannica. Medical science has made many leaps forward since it has been written. This is not a site for medical advice, when you need information on a medical condition, consult a professional instead.

FISTULA (Lat. for a pipe or tube), a term in surgery used to designate an abnormal communication leading either from the surface of the body to a normal cavity or canal, or from one normal cavity or canal to another. These communications are the result of disease or injury. They receive different names according to their situation: lachrymal fistula is the small opening left after the bursting of an abscess in the upper part of the tear-duct, near the root of the nose; salivary fistula is an opening into the salivary duct on the cheek; anal fistula, or fistula in ano, is a suppurating track near the outlet of the bowel; urethral fistula is the result of a giving way of the tissues behind a stricture. These are examples of the variety of the first kind of fistula; while recto-vesical fistula, a communication between the rectum and bladder, and vesico-vaginal fistula, a communication between the bladder and vagina, are examples of the second. The abnormal passage may be straight or tortuous, of considerable diameter or of narrow calibre. Fistulae may be caused by an obstruction of the normal channel, the result of disease or injury, which prevents, for example, the tears, saliva or urine, as the case may be, from escaping; their retention gives rise to inflammation and ulceration in order that an exit may be obtained by the formation of an abscess, which bursts, for example, into the gut or through the skin; the cavity does not close, and a fistula is the result. The fistulous channel remains open as long as the contents of the cavity or canal with which it is connected can pass through it. To obliterate the fistula one must remove the obstruction and encourage the flow along the natural channel; for example, one must open up the nasal duct so as to allow the tears to reach the nasal cavity, and the lachrymal fistula will close; and so also in the salivary and urethral fistulae. Sometimes it may be necessary to lay the channel freely open, to scrape out the unhealthy material which lines the track, and to encourage it to fill up from its deepest part, as in anal fistula; in other cases it may be necessary to pare the edges of the abnormal opening and stitch them together. (E. O.*)


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