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Gastrointestinal fistula

Entero-enteral fistula; Enterocutaneous fistula; Fistula - gastrointestinal

 

A gastrointestinal fistula is an abnormal opening in the stomach or intestines that allows the contents to leak.

  • Leaks that go through to a part of the intestines are called entero-enteral fistulas.
  • Leaks that go through to the skin are called enterocutaneous fistulas.
  • Other organs can be involved, such as the bladder, vagina, anus, and colon.

Causes

 

Most gastrointestinal fistulas occur after surgery. Other causes include:

  • Blockage in the intestine
  • Infection
  • Crohn disease
  • Radiation to the abdomen (most often given as part of cancer treatment)
  • Injury, such as deep wounds from stabbing or gunshot
  • Swallowing caustic substances (such as lye)

 

Symptoms

 

Depending on where the leak is, these fistulas may cause diarrhea, and poor absorption of nutrients. Your body may not have as much water and fluids as it needs.

  • Some fistulas may have no symptoms.
  • Other fistulas cause intestinal contents to leak through an opening in the skin.

 

Exams and Tests

 

Tests may include:

  • Barium swallow to look in the stomach or small bowel
  • Barium enema to look in the colon
  • CT scan of the abdomen to look for fistulas between loops of the intestines or areas of infection
  • Fistulogram, in which contrast dye is injected into the opening of the skin of a fistula and x-rays are taken

 

Treatment

 

Treatments may include:

  • Antibiotics
  • Immune suppressing medicines if the fistula is a result of Crohn disease
  • Surgery to remove the fistula and part of the intestines if the fistula is not healing
  • Nutrition through a vein while the fistula heals (in some cases)

Some fistulas close on their own after a few weeks to months.

 

Outlook (Prognosis)

 

The outlook depends on the person's overall health and how bad the fistula is. People who are otherwise healthy have a very good chance of recovery.

 

Possible Complications

 

Fistulas may result in malnutrition and dehydration, depending on their location in the intestine. They may also cause skin problems and infection.

 

When to Contact a Medical Professional

 

Call your health care provider if you have:

  • Very bad diarrhea or other major change in bowel habits
  • Leakage of fluid from an opening on the abdomen or near the anus, especially if you have recently had abdominal surgery

 

 

References

De Prisco G, Celinski S, Spak CW. Abdominal abscesses and gastrointestinal fistuals. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 28.

Lichtenstein GR. Inflammatory bowel disease. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 141.

Nandakumar G, Michelassi F. Crohn disease. In: Yeo CJ, ed. Shackleford's Surgery of the Alimentary Tract. 7th ed. Philadelphia, PA: Elsevier Saunders; 2013:chap 71.

 
  • Digestive system organs

    Digestive system organs - illustration

    The digestive system organs in the abdominal cavity include the liver, gallbladder, stomach, small intestine and large intestine.

    Digestive system organs

    illustration

  • Fistula

    Fistula - illustration

    A fistula is an abnormal connection between an organ, vessel, or intestine and another organ, vessel or intestine, or the skin. Fistulas can be thought of as tubes connecting internal tubular structures, such as arteries, veins, or intestine, to one another or to the skin. Fistulas are usually the result of trauma or surgery, but can also result from infection or inflammation.

    Fistula

    illustration

    • Digestive system organs

      Digestive system organs - illustration

      The digestive system organs in the abdominal cavity include the liver, gallbladder, stomach, small intestine and large intestine.

      Digestive system organs

      illustration

    • Fistula

      Fistula - illustration

      A fistula is an abnormal connection between an organ, vessel, or intestine and another organ, vessel or intestine, or the skin. Fistulas can be thought of as tubes connecting internal tubular structures, such as arteries, veins, or intestine, to one another or to the skin. Fistulas are usually the result of trauma or surgery, but can also result from infection or inflammation.

      Fistula

      illustration

    A Closer Look

     

      Talking to your MD

       

        Self Care

         

          Tests for Gastrointestinal fistula

           

             

            Review Date: 5/11/2016

            Reviewed By: Subodh K. Lal, MD, gastroenterologist with Gastrointestinal Specialists of Georgia, Austell, GA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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