| Fistula | |
|---|---|
 | |
| AbdominalCT scan with right colocutaneous fistula and associated subcutaneouspneumatosis | |
| Pronunciation | |
| Specialty | General surgery |
Inanatomy, afistula (pl.:fistulas orfistulae/-li,-laɪ/; fromLatinfistula, "tube, pipe") is an abnormalconnection (i.e. tube) joining two hollow spaces (technically, twoepithelialized surfaces), such asblood vessels,intestines, or other holloworgans to each other, often resulting in an abnormal flow of fluid from one space to the other.[2][3][4] Ananal fistula connects theanal canal to theperianal skin. An anovaginal orrectovaginal fistula is a hole joining the anus orrectum to thevagina. A colovaginal fistula joins the space in the colon to that in the vagina. A urinary tract fistula is an abnormal opening in theurinary tract or an abnormal connection between the urinary tract and another organ. An abnormal communication (i.e. hole or tube) between thebladder and theuterus is called avesicouterine fistula, while if it is between the bladder and the vagina it is known as avesicovaginal fistula, and if between theurethra and the vagina: a urethrovaginal fistula. When occurring between two parts of the intestine, it is known as an enteroenteral fistula, between thesmall intestine and the skin it is known 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] Many result from complications during childbirth. Sometimes a fistula is deliberately surgically created as part of a treatment, for example in the case of anarteriovenous fistula forhemodialysis.[6]
The treatment for a fistula varies depending on the type, cause, and severity of the fistula, but often involves surgical intervention combined withantibiotic 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] Typically they are vaginal fistulas, between either the bowel or bladder and the vaginal canal, but uterine and bowel fistulas also occur.
Inbotany, the term is most common in its adjectival forms, where it is used inbinomial 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]
A fistula is an abnormalconnection betweenvessels ororgans that do not usually connect. It can be due to a disease or trauma, or purposely surgically created.[3][5]
Various types of fistulas include:
Although most fistulas are in forms of a tube, some can also have multiple branches.[9]
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 theInternational Statistical Classification of Diseases and Related Health Problems.
Treatment for fistula varies depending on the cause and extent of the fistula, but often involves surgical intervention combined withantibiotic 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 thatpus may escape without forming anabscess). Various surgical procedures are used, most commonlyfistulotomy, placement of aseton (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 inCrohn'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%).
In people withkidney failure, requiring dialysis, acimino fistula is often deliberately created in the arm by means of a short day surgery in order to permit easier withdrawal of blood forhemodialysis.[citation needed]
As a radical treatment forportal hypertension, surgical creation of a portacaval fistula produces an anastomosis between thehepatic portal vein and theinferior 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]
Globally, every year between 50,000 and 100,000 women are affected by fistula relating to childbirth.[7]
Inbotany, the term is most common in its adjectival forms, where it is used inbinomial 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, andAcacia seyal subsp.fistula is the subspecies with hollow spines.[citation needed]
The term was first used in the 14th century.[2]
A fistula plays a central role inWilliam Shakespeares playAll's Well That Ends Well
A fistula is an abnormal connection or passageway between organs or vessels that are not normally connected.
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