Fistula - Know Forms Of It!

A fistula is an abnormal connection between two hollow spaces (epithelial surfaces), such as blood vessels, intestines, or other hollow organs. Fistulas are usually caused by injuries or surgeries resulting in infection or inflammation. Also sometimes fistulae are created for therapeutic purpose.

Types of fistulas include:

1. Blind - with only one open end. Also known as sinus tracts
2. Complete - with both external and internal openings
3. Incomplete - a fistula with an external skin opening, which does not connect to any internal organ

Location:

1. Eye, adnexa, ear, and mastoid process: Lacrimal fistula, carotid cavernous fistula, mastoid fistula, craniosinus fistula, labyrinthine fistula, perilymph fistula, and preauricular fistula
2. Circulatory system: Coronary arteriovenous fistula, arteriovenous fistula of pulmonary vessels, pulmonary arteriovenous fistula, cerebral arteriovenous fistula, arteriovenous fistula, and fistula of the artery
3. Respiratory system: Pyothorax with fistula and tracheoesophageal fistula
4. Digestive system: Duodeno biliary fistula, salivary gland fistula, fistula of stomach and duodenum,  gastrocolic fistula, gastrojejunocolic fistula, enterocutaneous fistula, gastric fistula, fistula of appendix, anal and rectal fissures and fistulas, anal fistula, anorectal fistula, fistula of intestine, enteroentral fistula, fistula of gallbladder, biliary fistula, and pancreatic fistula
5. Musculoskeletal system and connective tissue: Fistula of joint
6. Urogenital system: Vesicointestinal fistula, urethral fistula, vesicovaginal fistula, cervical fistula, enterovaginal fistula, and rectovaginal
7. Congenital malformations, deformations and chromosomal abnormalities: Congenital preauricular fistula, Portal vein-hepatic artery fistula, congenital fistula of lip, Congenital fistula of salivary gland, congenital absence, atresia and stenosis of the rectum with fistula, congenital fistula of rectum and anus, congenital fistulae between uterus and digestive tract, and congenital rectovaginal fistula

Causes:

1. Inflammatory bowel disease causes of anorectal, enteroenteral, and enterocutaneous fistulas.
2. Complications from gallbladder surgery can lead to biliary fistula.
3. Radiation therapy, obstructed labor can lead to vesicovaginal and rectovaginal fistulas. Also, vesicovaginal and rectovaginal fistulas may also be caused by rape with foreign objects.
4. Obstetric fistula develops when the blood supply to the tissues of the vagina, bladder (and/or rectum) is cut off during prolonged obstructed labor.
5. Head trauma can lead to perilymph fistulas.
6. Trauma to other parts of the body can cause arteriovenous fistulas.
7. External causes include traumatic arteriovenous fistula and persistent postoperative fistula.

Physical examination: to determine the extent and pathway of the fistula

Treatment:

1. Treatment for fistula depends on the cause and extent of the fistula.
2. Surgery is often required to assure adequate drainage of the fistula. The surgical intervention combined with antibiotic therapy is usually required
3. In some cases, fistula is temporarily covered e.g. cleft palate fistula is treated with a palatal obturator to delay the need for surgery to a more appropriate age.
4. Surgical procedures commonly used are fistulotomy, placement of a seton (a cord that is passed through the path of the fistula to keep it open for draining)
5. Filling the fistula with fibrin glue