Fistula is an abnormal connection between two structures. Gastrointestinal fistula can form between the intestine and nearby organ or it may involve the area of rectum or anus with skin surrounding the anus. Because of the abnormal connection, fluid and intestinal content can leak into the connecting structures leading to increased risk of infection.
Gastrointestinal fistula can be congenital or acquired. Fistula can develop when the underlying disease affects the intestinal wall or it may occur as a result of injury to the normal gut. Most often gastrointestinal fistula occurs after intestinal surgery or chronic diseases of intestine such as Crohn’s disease etc.
Presenting symptoms are pain in abdomen, obstruction, fever, diarrhea, dehydration, skin infection etc. Treatment consists of use of antibiotics, intravenous fluids before any surgical repair is initiated. With proper treatment the prognosis of this condition is good.
What Causes A Gastrogastric Fistula To Form?
Gastrointestinal fistula can occur in anyone and at any age. Most gastrointestinal fistulas develop as a complication of intestinal surgery. Few fistulas have congenital origin. In some patients the cause is not known and it occurs spontaneously.
Following are the usual causes for development of GI fistula:
- After intestinal surgery
- Congenital defect
- Ulcerative colitis, Crohn’s disease, pancreatitis, and other inflammatory conditions of intestine.
- Gastrointestinal fistula occasionally occurs due to trauma from sharp instruments or blunt objects in the abdomen.
- Exposure to radiation while treating cancer of abdominal organs.
- Intestinal and gynecological malignancies.
- An abscess in the abdominal organ.
- Intestinal obstruction
- Malnutrition
Symptoms Of Gastrointestinal Fistula
The symptoms of GI fistula may depend on the type of fistula. There are two prominent types of fistulas; internal and external GI fistula. Internal fistula is connection between the intestinal tract and another internal organ, peritoneum, retroperitoneum or the lungs.
External fistula is abnormal connection between the skin and any part of the GI tract. Fistula in anus is common and it is a tract formed with granulation tissue which has primary opening in the anus and the other opening in the perianal skin area.
Symptoms of external fistula:
- Discharge oozing out of the skin.
- Pain in abdomen
- Fever
Symptoms of internal GI fistula:
- Pain in abdomen
- Diarrhea
- Bleeding from rectum
- Dehydration
- Fever and blood infection
- Weight loss due to poor absorption of nutrients from the gut.
Diagnosis And Treatment Of Gastrointestinal Fistula
Gastrointestinal fistula can be diagnosed with complete medical history, clinical examination and with following tests:
- Blood test to check electrolyte level and white blood cell count.
- MRI and CT scan.
- X-ray barium swallow.
- X-ray barium enema if fistula in colon is suspected.
- Endoscopy of upper and lower gastrointestinal tract.
- Fistulogram: In this process a dye in injected in the opening of the fistula on the skin and consequently X-rays are taken to follow the tract of fistula.
Treatment of gastrointestinal fistula depends on the underlying cause as well as the severity of symptoms. Usually the treatment begins with conservative approach before surgical repair is performed. Patient is treated with antibiotics, intravenous fluids, and in some cases steroids. Steroids are usually used in diseases such as ulcerative colitis and Crohn’s disease. In case if one end of fistula is on the skin applying antibiotic skin cream helps to protect from infection.
Some small fistulas often heal with conservative treatment, proper nutrition and overall good health. However, if the lesion does not heal after few weeks of treatment, surgery is necessary to repair the fistula. Surgical intervention consists of opening and drainage of fistula and removing the fistula tract.