In anatomy, a fistula (pl.: fistulas or fistulae/-li,-laɪ/; from Latinfistula, "tube, pipe") is an abnormal connection (i.e. tube) joining two hollow spaces (technically, two epithelialized surfaces), such as blood vessels, intestines, or other hollow organs to each other, often resulting in an abnormal flow of fluid from one space to the other.[2][3][4] An anal fistula connects the anal canal to the perianal skin. An anovaginal or rectovaginal fistula is a hole joining the anus or rectum to the vagina. A colovaginal fistula joins the space in the colon to that in the vagina. A urinary tract fistula is an abnormal opening in the urinary tract or an abnormal connection between the urinary tract and another organ. An abnormal communication (i.e. hole or tube) between the bladder and the uterus is called a vesicouterine fistula, while if it is between the bladder and the vagina it is known as a vesicovaginal fistula, and if between the urethra and the vagina: a 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 colon and the skin as a colocutaneous fistula.[3]
A fistula can result from an infection, inflammation, injury or surgery.[5] Sometimes a fistula is deliberately surgically created as part of a treatment, for example in the case of an arteriovenous fistula for hemodialysis.[6]
The treatment for a 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. A catheter may be required to drain a fistula.[3]
Globally, every year between 50,000 and 100,000 women are affected by one or more fistulas 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 a species that is distinguished by one or more 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]
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.[9]
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]
(K31.6) Gastrojejunocolic fistula – after a Billroth II a fistula forms between the transverse colon and the upper jejunum (which, post Billroth II, is attached to the remainder of the stomach). Fecal matter passes improperly from the colon to the stomach and causes halitosis.
(K60.5) Anorectal fistula (fecal fistula, fistula-in-ano): connecting the rectum or other anorectal area to the skin surface. This results in abnormal discharge of feces through an opening other than the anus.
(K63.2) Fistula of intestine
Enteroenteral fistula: between two parts of the intestine
Probed surgically excised gastrocutaneous fistula tract, that resulted from a previous gastrostomy tube.
Surgical and medical treatment: Complications from gallbladder surgery can lead to biliary fistulas.[13] 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.[10] Persistent gastrocutaneous fistulas can develop after gastrostomy.[14]
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.[10] 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 developed fistulae.[15][16] 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.[17] Head trauma can lead to perilymph fistulas, whereas trauma to other parts of the body can cause arteriovenous fistulas.[18]
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).[19]
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.[citation needed]
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.[citation needed]
Epidemiology
Globally, every year between 50,000 and 100,000 women are affected by fistula relating to childbirth.[7]
^Carr, S; Velasco, AL (January 2020). "Fistula In Ano". StatPearls Publishing. PMID32491449. Archived from the original on 12 January 2023. Retrieved 29 December 2020. ((cite journal)): Cite journal requires |journal= (help)
^Singhal, Shashideep MD2; Malieckal, Anju MD2; Culliford, Andrea MD1 Over the Scope Clip (OTSC) Closure of Persistently Leaking Gastrocutaneous Fistula after Failed Conventional Endoscopic Clipping Presidential Poster, American Journal of Gastroenterology: October 2012 - Volume 107 - Issue - p S532-S533
