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Gastrointestinal fistula

  • Definition
    • 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.
  • Alternative Names
    • Entero-enteral fistula; Enterocutaneous fistula; Fistula - gastrointestinal

  • 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.