fistula
A fistula is an unnatural connection between two anatomical structures that actually have to be separated from each other. Fistulas can run inside the body, for example between two organs or cavities, or they can form an unnatural connection between the inside of the body and the surface of the body. Here you can read about the symptoms that trigger fistulas, their causes and how fistulas are treated.
What is a fistula?
In the case of a fistula, anatomical structures that normally have to be separated from one another - for example the vagina and the rectum - are connected to one another via a so-called fistula duct. The fistula can connect two cavities in the body (inner fistula) or one cavity inside the body with the body surface (outer fistula). This unnatural connection can trigger various ailments.
Note:
The term fistula comes from the Latin word "fistula". That means something like "tube".
Fistulas are either congenital or they develop in the course of life - for example as a result of pathological processes or injuries. For medical reasons, a fistula can also be created artificially. This happens, for example, when the urine from the bladder has to be diverted permanently through the abdominal wall via a tube.
What types of fistulas are there?
Fistulas can develop anywhere in the body and affect a wide variety of structures. The extent of the fistula also varies from case to case. Doctors therefore differentiate between fistulas according to various criteria.
Differentiation of the fistulas according to their location
Which organs and structures the fistula connects with each other is an important differentiator. Doctors differentiate between:
- internal fistulas
- external fistulas
Internal fistula
An internal fistula is the unnatural connection between two cavities or organs within the body. The fistula can, for example, connect the intestine and vagina (rectovaginal fistula).
For example, the following fistulas are internal fistulas:
Fisting of blood vessels (arteriovenous fistula, also called AV fistula): They can occur anywhere in the body where veins and arteries are close together. Examples are:
- Carotid cavernous fistula, or CSCF for short, a fistula on the carotid artery
- Fistula on the blood vessels of the meninges (dural AV fistula)
- Fistula between the abdominal artery and the inferior vena cava (aortocaval fistula)
Mainly these internal fistulas appear in the area of the head and neck:
- Perilymph fistula (inner ear and middle ear are not completely separated)
- Esophagotracheal fistula (connection between esophagus and trachea)
Often, internal fistulas affect structures of the digestive tract and genital area. Some examples:
- Bladder-vaginal fistula, also called a vesicovaginal fistula (unnatural connection between the bladder and vagina)
- Connection between the intestine and vagina (rectovaginal fistula)
- Fistula duct between structures of the anal canal and the rectum (certain type of anal fistula)
Anal fistula What is an anal fistula? How do you get them and how do you get rid of them? Where does it come from, does it heal on its own, and is it dangerous? Read everything you need to know about anal fistula here! Learn more
External fistula
In the case of an external fistula, a hollow organ is unnaturally connected to the body surface via a tubular opening. An example of this is the lymphatic fistula. A lymph node opens towards the surface of the body and breaks through the skin.
Other external fistulas are in the head area:
- Tooth fistula (abscess under the tooth makes its way into the oral cavity)
- Fistula on the ear connects the auricle with the surface of the skin (preacular fistula)
External fistulas also occur in the anal and genital areas:
- Perianal fistula (when the fistula duct connects the anal canal or rectum to the surface of the skin around the anus)
- Pilonidal fistula (coccyx fistula)
Differentiation of the fistulas according to their severity
Another distinguishing feature of a fistula is the individual characteristics.
Complete fistula
A complete fistula is understood to be a complete breakthrough, either between two organs (internal fistula, e.g. esophagus and trachea) or between an organ and the body surface (external fistula, e.g. anal fistula).
If, for example, there is a complete anal fistula, a second, unnatural anus develops near the anus. The tissue between the anal canal and the skin is completely perforated. As a result, secretions, pus, and stool can leak out of the fistulous duct.
Incomplete fistula
Doctors speak of an incomplete fistula if there is only one opening (ostium). It is, as it were, the approach of the fistula duct, which, however, does not yet end in another cavity or on the surface. It (still) ends blindly in the tissue.
Both internal and external fistulas can be incomplete. The ostium can either be on the outside, i.e. on the skin. However, it can also be on the side of the mucous membrane, i.e. inside the body.
How do you recognize a fistula?
An external fistula that ends on the surface of the body can be seen with the naked eye in many of those affected and, if it has not broken through permanently, is reminiscent of a pus-filled pimple. Such an external fistula causes these symptoms:
- Reddening of the skin
- swelling
- overheat
- pains
- itching
- Sensation of pressure in the affected skin area
- Secretion leakage (depending on the location and connection of the fistula, pus, feces, lymph fluid, blood)
In contrast to a pimple, there is only a short-term improvement after opening and emptying the pus. The skin opening does not heal, but there is a continuous outflow of body fluids.
Note:
Not every external fistula causes discomfort unless it breaks through. Some patients only notice the change in the skin.
An internal fistula shows up with typical inflammatory symptoms. This includes:
- fever
- Exhaustion
- Pain in the affected area (e.g. symptom of a fistula between the intestine and vagina)
- Coughing and irritation or inflammation of the bronchi in fistulas between the esophagus and windpipe (esophagotracheal fistulas)
Fistulas are very uncomfortable in many cases. An external fistula in the anal area, for example, can mean that the person concerned can no longer sit pain-free. Constant discharge of pus, feces or other body fluids can also limit everyday life extremely and put a lot of psychological stress on the patient.
How do fistulas arise?
Why do you get a fistula? There are several causes of fistulas:
Embryonic Development Disorders
Fistulas can develop during the development of the unborn child in the womb. Connections between hollow organs or cavities usually close by the time of birth. If such a connection remains open, it is called a congenital fistula.
An example is the esophagotracheal fistula. Normally the esophagus and trachea emerge from a common cavity during embryonic development, which matures into two closed tubes by the time of birth.
Inflammatory processes and diseases
A pathological fistula is caused by inflammatory processes in the body. If a purulent abscess forms in the body, it puts pressure on the surrounding tissue. If the pressure becomes too high, a tubular connection forms between the pus-filled cavity and the surface of the skin or another cavity.
Many diseases cause inflammatory processes in the body. One example is chronic inflammatory bowel diseases such as Crohn's disease. These diseases also increase the risk of developing fistulas. Tumor diseases are also a risk factor. If the ulcer presses on the surrounding tissue, defects arise there and fistulas can form.
These diseases are common causes of fistulas:
- Crohn's disease
- Diverticulitis
- tuberculosis
- Tumor diseases
Injuries and trauma
Injuries are another possible cause of fistulas to develop. For example, if a vein and an adjacent artery are injured in a trauma in such a way that a connection is created, doctors speak of an arteriovenous fistula. It develops within a few hours. Such an injury is usually caused by the use of force, for example a knife or a bullet.
But medical interventions can also cause fistulas. If the doctor injures blood vessels or organs during a cardiac catheter examination or a biopsy, for example, a fistula can form.
Operations (artificial fistula)
An artificial fistula can be used to treat various diseases. A doctor creates direct access to the body - for example with artificial nutrition. He uses a hollow needle puncture to insert an artificial tube through the abdominal wall directly into the stomach. For example, a special preparation can be given directly to the stomach - after a stroke or in coma patients, for example.
Another frequently used fistula is the suprapubic bladder fistula for direct drainage of urine from the urinary bladder. To do this, a tube is inserted above the pubic bone (suprapubic) through the abdominal wall and the bladder wall into the urinary bladder.
How is a fistula diagnosed?
The fistula diagnosis is made very differently depending on the type of fistula. At the beginning there is the anamnesis, i.e. a detailed discussion between doctor and patient. The doctor asks the person concerned about the nature of their symptoms, when they first appeared and whether any previous illnesses are known.
A physical exam will follow. The doctor looks for changes on the surface of the skin or signs of inflammation under the skin. During this physical examination, an external fistula can usually already be seen and the doctor can make the diagnosis.
Imaging procedures
If an internal fistula is suspected, further examinations are necessary. Depending on the region of the body, the doctor will first take pictures of the inside of the body. Various methods are available to him:
- Computed tomography
- Magnetic resonance tomography
- Ultrasound examination
The recordings make changes in the tissue and thus unnatural fistula ducts visible. Contrast media is sometimes used in the examinations so that the course of the fistula can be seen more clearly.
Endoscopy to diagnose fistulas
In some cases, the attending physician uses the opportunity to look inside the body with the help of an endoscope. This examination is called endoscopy. It may be necessary if the previously created images do not allow a specific diagnosis.
Endoscopy can also rule out or confirm various diseases as the cause of the fistula. A reflection is possible, for example, in the lungs and chest, bronchi, gastrointestinal tract, abdomen and the bladder.
Treatment of fistulas
Very few fistulas heal on their own. In most cases, medical treatment is necessary to get rid of the symptoms and prevent possible consequences of the fistula. As a rule, the earlier a fistula is identified and treated, the better the prognosis.
How a fistula is treated always depends on the cause, location and severity.
Conservative treatment
Some fistulas can be treated without surgery. However, this only applies to anal fistulas that occur as part of an inflammatory bowel disease. The administration of antibiotics closes the fistula. However, the relapse rate is high after conservative therapy.
Fistula surgery
External fistulas that end on the body surface are surgically removed in most cases. First, the fistula is opened and the body fluids it contains are removed. If there are bacteria or other germs in the fistula duct, the inflamed and infected tissue must be removed. The doctor then closes the fistula so that no new secretion can flow.
Internal fistulas are also closed surgically. Various methods are available for this. The attending physician discusses with the patient which is suitable in the individual case.
After the surgery, antibiotics prevent bacterial inflammation of the surgical area.
Fistula: which doctor is responsible?
If you suspect you have a fistula, contact your doctor. The first examination can sometimes diagnose external fistulas. If necessary, he will refer you to a specialist.
This can be a dermatologist (dermatologist), a gynecologist (gynecologist), an internal medicine doctor (internist), a specialist in gastrointestinal disorders (gastroenterologist) or a urologist. Which doctor will handle the treatment depends on which organs are affected by the fistula and what is the cause.
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