Fistula

A fistula (plural: fistulas or fistulae /-li, -laɪ/; from Latin fistula, "tube, pipe") is an abnormal connection between two hollow spaces (technically, two epithelialized surfaces), such as blood vessels, intestines, or other hollow organs.[2][3][4]

Not to be confused with Vistula.
This article is about the anatomical term. For the former legume subgenus, see Cassia (genus). For the metal straw used in Catholic liturgy, see Fistula (liturgical object).
Fistula
Abdominal CT scan with right colocutaneous fistula and associated subcutaneous pneumatosis
Pronunciation
SpecialtyGeneral surgery

Types of fistula can be described by their location. Anal fistulas connect between the anal canal and the perianal skin. Anovaginal or rectovaginal fistulas occur when a hole develops between the anus or rectum and the vagina. Colovaginal fistulas occur between the colon and the vagina. Urinary tract fistulas are abnormal openings within the urinary tract or an abnormal connection between the urinary tract and another organ such as between the bladder and the uterus in a[vesicouterine fistula, between the bladder and the vagina in a vesicovaginal fistula, and between the urethra and the vagina in urethrovaginal fistula. When occurring between two parts of the intestine, it is known as an enteroenteral fistula, between the small intestine and the skin as an enterocutaneous fistula, and between the small intestine and the colon as a colocutaneous fistula.[3]

Fistulas can result from an infection or inflammation, injury or surgery.[5] Fistulas are sometimes purposefully surgically created as part of a treatment, for example arteriovenous fistulas for hemodialysis.[6]

Treatment for fistula varies depending on the cause and extent of the fistula, but often involves surgical intervention combined with antibiotic therapy. In some cases the fistula is temporarily covered using a fibrin glue or plug. Catheters may be required to drain a fistula.[3]

Globally, every year between 50,000 to 100,000 women are affected by fistula relating to childbirth.[7]

In botany, the term is most common in its adjectival forms, where it is used in binomial names to refer to species that are distinguished by hollow or tubular structures. Monarda fistulosa, for example, has tubular flowers.[8]

The term was first used in the 14th century.[2]

Definition

A fistula is an abnormal connection between vessels or organs that do not usually connect. It can be due to a disease or trauma, or purposely surgically created.[3][5]

Classification

Various types of fistulas include:

  • Blind: Only one open end; may also be called sinus tracts.[5]
  • Complete: Both internal and external openings.[5]
  • Incomplete: An external skin opening that does not connect to any internal organ.[5]

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

Location

Types of fistula can be described by their location. Anal fistulas connect between the epithelialized surface of the anal canal and the perianal skin. Anovaginal or rectovaginal fistulas occur when a hole develops between the anus or rectum and the vagina. Colovaginal fistulas occur between the colon and the vagina. Urinary tract fistulas are abnormal openings within the urinary tract or an abnormal connection between the urinary tract and another organ such as between the bladder and the uterus in a vesicouterine fistula, between the bladder and the vagina in a vesicovaginal fistula, and between the urethra and the vagina in urethrovaginal fistula. When occurring between two parts of the intestine, it is known as an enteroenteral fistula, between the small intestine and the skin as an enterocutaneous fistula, and between the small intestine and the colon as a colocutaneous fistula.[3]

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

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

Causes
  • Surgical and medical treatment: Complications from gallbladder surgery can lead to biliary fistulas. As well as being congenital or resulting from trauma, arteriovenous fistulas are created purposefully for hemodialysis.[6] Radiation therapy to the pelvis can lead to vesicovaginal fistulas.[9]
  • Trauma: Prolonged childbirth can lead to fistulas in women, in whom abnormal connections may occur between the bladder and vagina, or the rectum and vagina.[9] 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.[12][13] In 2003, thousands of women in eastern Congo presented themselves for treatment of traumatic fistulas caused by systematic, violent gang rape, often also with sharp objects 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.[14] Head trauma can lead to perilymph fistulas, whereas trauma to other parts of the body can cause arteriovenous fistulas.

Treatment

Treatment for fistula varies depending on the cause and extent of the fistula, but often involves surgical intervention combined with antibiotic therapy. In some cases the fistula is temporarily covered, using a fibrin glue or plug. Catheters may be required to drain a fistula.[3]

Surgery is often required to assure adequate drainage of the fistula (so that pus may escape without forming an abscess). Various surgical procedures are 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).

Management involves treating any underlying causative condition. 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 the fistula is very high (well above 50%).

Therapeutic use

In people with kidney failure, requiring dialysis, 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.

Epidemiology

Globally, every year between 50,000 to 100,000 women are affected by fistula relating to childbirth.[7]

Botany

In botany, the term is most common in its adjectival forms, where it is used in binomial names to refer to species that are distinguished by hollow or tubular structures. Monarda fistulosa, for example, has tubular flowers;[8] Eutrochium fistulosum has a tubular stem; Allium fistulosum has hollow or tubular leaves, and Acacia seyal subsp. fistula is the subspecies with hollow spines.

Society and culture

The term was first used in the 14th century.[2]

See also

References
  1. Oxford English Dictionary. OED 2nd edition, 1989. (subscription required)
  2. "Definition of Fistula". www.merriam-webster.com. Retrieved 28 December 2020.
  3. "What Is A Fistula? Types, causes and treatments explained". Urinary incontinence education; National Association for Continence. Retrieved 28 December 2020.
  4. Garefalakis, Maria; Hickey, Martha; Johnson, Neil (2016). "Gynecological Morbidity". In Quah, Stella R.; Cockerham, William C. (eds.). International Encyclopedia of Public Health (Second ed.). Elsevier. pp. 342–353. doi:10.1016/b978-0-12-803678-5.00178-8. ISBN 978-0-12-803678-5. A fistula is an abnormal connection or passageway between organs or vessels that are not normally connected.
  5. Rao, Jyotsna (2019). "Section II. General Surgery: Wounds, Sinuses, Fistulae". Qrs for Bds III Year-E Book (Third ed.). Elsevier Health Sciences. p. 256. ISBN 978-81-312-5535-3.
  6. "Arteriovenous fistula - Symptoms and causes". Mayo Clinic. Retrieved 2019-12-05.
  7. "Obstetric fistula". www.who.int.
  8. Identification of Monarda fistulosa Archived 2016-03-04 at the Wayback Machine subpage of Discover Life , 2014.
  9. "Fistulas: What are Fistulas? Fistulas Symptoms, Treatment, Diagnosis - UCLA". www.uclahealth.org. Retrieved 29 December 2020.
  10. Carr, S; Velasco, AL (January 2020). "Fistula In Ano". StatPearls Publishing. PMID 32491449. Cite journal requires |journal= (help)
  11. Seksik, Philippe; Contou, Jean-Francois; Cosnes, Anne; Cosnes, Jacques (2006). "7. Hidradenitis Suppurativa and Crohn's Disease". In Jemec, Gregor B. E.; Revuz, Jean; Leyden, James J. (eds.). Hidradenitis Suppurativa. Springer. p. 53. ISBN 978-3-540-33100-1.
  12. "Stephanie Nolen, "Not Women Anymore…" Ms. Magazine, Spring 2005". Archived from the original on 2017-01-20. Retrieved 2007-12-11.
  13. UNFPA: United Nations Population Fund. Press Release, 22 June 2006. "More Funding Needed to Help Victims of Sexual Violence"
  14. Emily Wax, Washington Post Foreign Service. Saturday, October 25, 2003; Page A01 "A Brutal Legacy of Congo War"
Classification
External resources
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