Fistula

In medicine, a fistula (pl. fistulas or fistulae) is an abnormal connection or passageway between organs or vessels that normally do not connect.

Location of fistulas

Fistulas can develop in various parts of the body, including (sorted by International Statistical Classification of Diseases and Related Health Problems):

H: Diseases of the eye, adnexa, ear, and mastoid process

• (H04.6) Lacrimal fistula

• (H70.1) Mastoid fistula
  • Craniosinus fistula: between the intracranial spaceand a paranasal sinus

• (H83.1) Labyrinthine fistula
  • Perilymph fistula: tear between the membranes between the middle and inner ears

I: Diseases of the circulatory system

• (I25.4) Coronary arteriovenous fistula, acquired

• (I28.0) Arteriovenous fistulaof pulmonary vessels
  • Pulmonary arteriovenous fistula: between an artery and vein of the lungs, resulting in shuntingof blood. This results in improperly oxygenated blood

• (I67.1) Cerebral arteriovenous fistula, acquired

• (I77.0) Arteriovenous fistula, acquired

• (I77.2) Fistula of artery

J: Diseases of the respiratory system

• (J86.0) Pyothoraxwith fistula

• (J95.0) Tracheoesophageal fistulafollowing tracheostomy: between the breathing and the feeding tubes

K: Diseases of the digestive system

• (K11.4) Fistula of salivary gland

• (K31.6) Fistula of stomachand duodenum
• (K31.6) Gastrocolic fistula
• (K31.6) Gastrojejunocolic fistula
  • Enterocutaneous fistula: between the intestine and the skin surface, namely from the duodenumor the jejunumor the ileum. This definition excludes the fistulas arising from the colonor the appendix.
  • Gastric fistula: from the stomachto the skin surface

• (K38.3) Fistula of appendix

• (K603) Anal fistula
  • (K603) Anorectal fistula: connecting the rectumor other anorectalarea to the skinsurface. This results in abnormal discharge of fecesthrough an opening other than the anus. Also called fistula-in-ano.
    • Fecal fistula: see Anorectal
    • Fistula-in-ano: see Anorectal
• (K604) Rectal fistula
• (K605) Anorectal fistula

• (K63.2) Fistula of intestine
  • Enteroenteral fistula: between two parts of the intestine

• (K82.3) Fistula of gallbladder

• (K83.3) Fistula of bile duct
  • Biliary fistula: connecting the bileducts to the skin surface, often caused by gallbladdersurgery
  • Pancreatic fistula: between the pancreasand the exterior via the abdominal wall

M: Diseases of the musculoskeletal system and connective tissue

• (M25.1) Fistula of joint

N: Diseases of the genitourinary system

• (N32.1) Vesicointestinal fistula

• (N36.0) Urethral fistula
  • Innora:between the prostatic utricleand the outside of the body

• (N64.0) Fistula of nipple

• (N82) Fistulae involving female genital tract/ Obstetric fistula
  • (N82.0) Vesicovaginal fistula: between the bladderand the vagina
  • (N82.1) Other female urinary-genital tract fistulae
    • Cervical fistula: abnormal opening in the cervix
  • (N82.2) Fistula of vagina to small intestine
    • Enterovaginal fistula: between the intestineand the vagina
  • (N82.3) Fistula of vagina to large intestine
    • Rectovaginal: between the rectumand the vagina
  • (N82.4) Other female intestinal-genital tract fistulae
  • (N82.5) Female genital tract-skin fistulae
  • (N82.8) Other female genital tract fistulae
  • (N82.9) Female genital tract fistula, unspecified

Q: Congenital malformations, deformations and chromosomal abnormalities

• (Q18.0) Sinus, fistula and cystof branchial cleft

• (Q26.6) Portal vein-hepatic arteryfistula

• (Q38.0) Congenitalfistula of lip

• (Q38.4) Congenitalfistula of salivary gland

• (Q42.0) Congenitalabsence, atresiaand stenosisof rectumwith fistula

• (Q42.2) Congenitalabsence, atresiaand stenosisof anuswith fistula

• (Q43.6) Congenitalfistula of rectumand anus

• (Q51.7) Congenitalfistulae between uterusand digestiveand urinary tracts

• (Q52.2) Congenitalrectovaginal fistula

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:

• Diseases: Inflammatory bowel diseases, such as Crohn's diseaseand ulcerative colitis, are the leading causes of anorectal, enteroenteral, and enterocutaneous fistulas. A person with severe stage-3 hidradenitis suppurativawill also develop fistulas.

• Medical treatment: Complications from gallbladder surgery can lead to biliary fistula. Radiation therapy can lead to vesicovaginal fistula.

• 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. Vesicovaginal and rectovaginal fistulas may also be caused by rape, in particular gang rape, as evidenced by the abnormally high number of women in conflict areas, such as that of the Second Congo War, who have suffered fistulae.

Treatment

Treatment for fistulae varies depending on the cause and extent of the fistula, but often involves surgical intervention combined with antibiotictherapy.

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.

Surgery is often required to assure adequate drainage of the fistula (so that pusmay 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). 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 diseasecan be effective, but if the Crohn's disease itself is not treated, the rate of recurrence of fistula is very high (well above 50%).

See also

• Anastomosis

External links

• Cleveland Clinic - Anorectal Fistula
• Hemorrhoids In Plain English - Fistula-in-Ano
• Mayo Clinic - Arteriovenous Fistula
• American Urological Association - Bladder Fistula
• American Hearing Research Foundation - Perilymph Fistula
• The Fistula Foundation - Obstetric Fistulas
• Fistula Hospital in Ethiopia
• Washington Post articleon fistulae in conflict areas in the Democratic Republic of the Congo
• Campaign to end Fistula
• One by One - Funding Care for Women with Fistula
• SUDAN: Fighting fistula in Khartoum, IRIN, 16 November2005de:Fistel

fr:Fistule nl:Fistel no:Fistel

This article is licensed under the GNU Free Documentation License.
It uses material from the http://en.wikipedia.org/wiki/Fistula Wikipedia article Fistula.