What is a fistula? Symptoms and Treatment
A fistula is a canal that connects a body cavity or hollow organs to the external environment or to each other. Another fistula is called a fistula. Most often, it is represented by a narrow tubule, which is covered from the inside with epithelium or young connective tissue.
Fistulas can form against the background of various pathological processes occurring in the body, as well as after surgery.
Content:
- Types of fistulas
- Fistula structure
- Fistula symptoms
- Fistula causes
- Diagnosis of fistulas
- Fistula treatment
Types of fistulas
Fistulas are distinguished depending on their location in the body:
- Gastric fistula.
- Rectal fistula. It, in turn, is divided into anorectal (from the anus or rectum to the skin) and pararectal (leaves the anal crypt to the skin).
- Rectovaginal fistula that penetrates the rectovaginal septum in women.
- Duodenal fistula that affects the duodenum.
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Bronchial fistula, which connects the lumen of the bronchi with the pleura, etc.
- Depending on the origin of the fistula, it can be acquired or congenital. Congenital fistulas form during the intrauterine development of the fetus in the presence of any defects. More often than others, there are median and lateral fistulas of the neck, as well as fistulas of the navel. Acquired fistulas occur against the background of any pathological process, they can also be the result of injury or surgery.
- Sometimes doctors themselves form fistulas to improve the functioning of an organ if it is not possible to remove it. For example, for the outflow of urine, for the passage of the internal contents of the stomach, etc. Such fistulas are called "stomas".
- Depending on whether the fistula is combined with the external environment, it can be external or internal.
- External fistulas connect organs or pathological foci of tissue (bone) infection in the human body with the external environment. They are most often formed in various infectious diseases (pararectal, urinary, intestinal, osteomyelitis fistula).
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Internal fistulas connect organs to each other or to another cavity. For example, there are gastrointestinal, bronchial-pleural and other types of fistulas. They are formed during the decay of tissues against the background of pathological processes. When the adjacent organs are glued together and spliced with each other, then their gaps are connected to each other.
- Depending on the structure, fistulas are granulating, epithelial and labial.
- Depending on what content is separated from the canal, fistulas are salivary, urinary, purulent, mucous, liquor, fecal, etc.
Fistula structure
External fistulas always have two mouths: external and internal, which are connected to each other by a canal. Sometimes the channel may be missing. In this case, the wall of the organ is adjacent to the skin, or even protrudes above it.
Granulating fistulas are covered with granulation tissue. They are pathological, as they are formed against the background of inflammatory processes. The mechanism of their development is as follows:
- The inflammatory focus is delimited from the surrounding tissues, after which it breaks out.
- Due to the breakthrough, a channel is formed through which pathological contents exit.
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Over time, the canal becomes covered with granulation tissue, and connective scar tissue forms around it. The walls of the fistula become immobile and hardened.
To heal such a fistula does not allow the fact that any discharge constantly passes through it. If it has a chemically active formula, then this will destroy granulation and facilitate the penetration of toxins and microbes into adjacent tissues. As a result, scars will form around the fistula. In addition, suppuration of fistulas is fraught with the fact that abscesses and new phlegmon can form other fistulas that open in adjacent tissues. If the pathological content stops passing through the fistula canal, then it can heal on its own.
Epithelial fistulas are those fistulas whose canal walls are covered with epithelium. When the epithelium of the mucous membrane of an internal organ passes to the skin, then such fistulas are called labial. This name was given to fistulas due to the fact that their wall protrudes above the skin and resembles a human lip in appearance. Most often, such fistulas are formed in an artificial way. Self-epithelized fistulas cannot heal.
As for the discharge that comes out of the fistula cavity, it depends on which organ the fistula is associated with. The more aggressive this exudate, the more the skin around the fistula will be damaged. For example, with intestinal fistulas, the skin erodes very quickly and becomes covered with ulcers.
Fistulas are dangerous because they can lead to disturbances in the body. In addition, they are formed against the background of the inflammatory process, which means that their development is accompanied by intoxication and loss of fluid. All the same intestinal fistulas cause the outflow of the digestive fluid. In the future, this leads to a violation of the water-salt balance and metabolic disruptions.
If pathological changes in the body are very pronounced, then there is a risk of death of the patient.
Fistula symptoms
The clinical picture that characterizes the presence of a fistula depends on what exactly caused its formation and where it is located.
An external fistula is indicated by the presence of a hole in the skin, from which fluid is released. The appearance of this hole may be preceded by trauma to the corresponding area, inflammatory processes of nearby tissues and organs, as well as surgery.
The condition of the skin around it will depend on what kind of content is released from the mouth of the fistula. Dermatitis is usually observed near the gastric and duodenal fistula, since the skin is corroded by digestive juices. Near the urinary fistulas, the skin is edematous, and later elephantiasis forms.
As for the general reaction of the body, it can vary significantly. Deterioration of the condition will be observed when pathogenic microorganisms penetrate through the fistula and a secondary infection develops. A severe course of the disease is characteristic of purulent fistulas.
Internal fistulas are most often the result of complications of diseases of a chronic or acute course. For example, blockage of the bile ducts by calculus can lead to the formation of bile fistulas. In this case, the symptoms will depend on how much bile is excreted daily into the peritoneal cavity. A person may suffer from severe pain in the abdomen, from disruptions in the digestion process.
If a person has a broncho food fistula, then chronic aspiration pneumonia or bronchitis, which occurs against the background of food pieces entering the tracheobronchial tree, may indicate them.
If we consider fistulas of the rectum, then the following symptoms will indicate their presence:
- There will be a hole in the anus. It often remains barely noticeable. Fluid will constantly flow from this hole, possibly with pus. For this reason, the person will have to wear a pad.
- Painful sensations will be present in the anus. During a bowel movement, they always increase.
If a patient has a fistula on the gum, then the clinical picture is as follows:
- Teeth acquire pathological mobility;
- Gums hurt when touched;
- Sometimes, against the background of the development of inflammation, the body temperature rises;
- Pus is released from the fistula on the gum.
Fistula causes
There are two main reasons for the formation of fistulas:
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Pathological fistulas. They form independently due to various inflammatory processes occurring in the body.
Factors that can influence the occurrence of a pathological fistula:
- Trauma, as a result of which the membrane of an organ or vessel is damaged;
- Destructive processes of the chronic course: sclerosis of tissues, loss of their elasticity, softening of fibers, the presence of erosion and ulceration;
- Inflammatory reactions in the body, in which the formation of a fistula is only a protective reaction.
- Surgical fistulas. These channels are formed by the doctor. An example of such fistulas is gastrostomy, when the stomach communicates with the external environment through an artificially created opening through which a person temporarily receives food. Sometimes surgical fistulas are left permanently to allow communication between the internal organs.
Diagnosis of fistulas
Diagnosis of external fistulas, as a rule, is not difficult. The hole is visible to the naked eye. If pathological contents are released from the mouth of the fistula, then the patient is diagnosed. However, this does not mean that the survey is complete. It will continue, because it is necessary to establish the exact cause of the formation of the fistula. Only in this case it will be possible to prescribe the most effective treatment.
The simplest diagnostic method is probing. The fistulous course is examined with a probe. This allows you to determine its depth and the direction in which it leads. To find out if the fistula is connected to a hollow organ, a dye is injected into the patient. If it stands out from the opening of the fistula back, then the organ is not hollow.
Fistulography is also possible. During the examination procedure, the fistula is filled with a radiopaque substance and a series of images is taken.
Fibrogastroscopy, bronchoscopy, cystoscopy and other endoscopic examinations are performed depending on which organ the fistula is communicating with.
Against the background of inflammation, accompanied by tissue suppuration, the fistula may be invisible. For this reason, the diagnosis is sometimes delayed in time. This complicates subsequent treatment.
Fistula treatment
Only granulating fistulas are amenable to conservative treatment, since they are able to grow on their own when the pathological cause that caused them is eliminated.
It is very important to prevent the development of infection, for which the patient is prescribed antibiotics both locally in the form of injections (novocaine is used to reduce pain), and systemically.
The skin around the fistulas is treated with high quality and sterile dressings with petroleum jelly or Lassar's paste are applied. In parallel, symptomatic and restorative therapy is carried out. Shown are balanced nutrition, vitamin injections, glucose infusion, etc.
The operation is prescribed for epithelial fistulas, since they cannot overgrow on their own. Also, surgical intervention is carried out with granulating fistulas, which do not heal for a long time.
Features of the surgical treatment of different types of fistulas:
- Epithelial fistulas. An important point during the operation is not only the elimination of the pathological focus, but also the qualitative removal of the epithelial cover of the fistula itself.
- Lipoid fistulas. The organ from which the fistula comes is separated from all surrounding tissues by the diameter of the mouth. The existing hole is sutured in such a way that it turns out to be turned inside the organ cavity. If the cicatricial changes are very pronounced, then the removal of the entire organ may be required.
- Granulating fistulas. During the operation, it is imperative to remove all dead tissue, foreign bodies, sequesters, etc. It is important to ensure a high-quality outflow from the existing wound, but in no case through the fistula canal.
After the operation, the patient is prescribed antibacterial treatment, and the body is detoxified. It is possible to use physiotherapy, for example, UHF or ultraviolet radiation.
It should be remembered that one of the most important points to achieve success in the treatment of fistulas is quality care for them. In addition to impeccable processing and toilet of the skin, it is necessary to use protective pastes that will not allow infection.
The author of the article: Volkov Dmitry Sergeevich | c. m. n. surgeon, phlebologist
Education: Moscow State University of Medicine and Dentistry (1996). In 2003 he received a diploma from the Educational and Scientific Medical Center of the Presidential Administration of the Russian Federation.
