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Fistula

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Template:Short description Template:About Template:Distinguish Template:Use dmy dates Template:Infobox medical condition

In anatomy, a fistula (Template:Plural form: fistulas or fistulae Template:IPAc-en; from Latin fistula, "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.<ref name=Webster/><ref name="NAFC">{{#invoke:citation/CS1|citation |CitationClass=web }}</ref><ref name="Garefalakis Hickey Johnson 2017 pp. 342–353">Template:Cite book</ref> 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 it is known as an enterocutaneous fistula, and between the colon and the skin as a colocutaneous fistula.<ref name="NAFC" />

A fistula can result from an infection, inflammation, injury or surgery.<ref name=Rao/> Many result from complications during childbirth. Sometimes a fistula is deliberately surgically created as part of a treatment, for example in the case of an arteriovenous fistula for hemodialysis.<ref name=Mayo>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>

The treatment for a fistula varies depending on the type, cause, and severity 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.<ref name="NAFC" />

Globally, every year between 50,000 and 100,000 women are affected by one or more fistulas relating to childbirth.<ref name="WHO2018" /> Typically they are vaginal fistulas, between either the bowel or bladder and the vaginal canal, but uterine and bowel fistulas also occur.

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.<ref name="Lamiaceae">Identification of Monarda fistulosa Template:Webarchive subpage of Discover Life Template:Webarchive , 2014.</ref>

The term was first used in the 14th century.<ref name="Webster" />

DefinitionEdit

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.<ref name="NAFC"/><ref name=Rao>Template:Cite book</ref>

ClassificationEdit

Various types of fistulas include:

  • Template:AnchorBlind: Only one open end; may also be called sinus tracts.<ref name=Rao/>
  • Template:AnchorComplete: Both internal and external openings.<ref name=Rao/>
  • Template:AnchorIncomplete: An external skin opening that does not connect to any internal organ.<ref name=Rao/>

Although most fistulas are in forms of a tube, some can also have multiple branches.<ref>Template:Cite journal</ref>

LocationEdit

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.<ref name="NAFC"/>

The following list is sorted by the International Statistical Classification of Diseases and Related Health Problems.

H: Diseases of the eye, adnexa, ear, and mastoid processEdit

I: Diseases of the circulatory systemEdit

J: Diseases of the respiratory systemEdit

K: Diseases of the digestive systemEdit

File:Duodeno Biliary Fistula 08786.jpg
Duodeno Biliary Fistula

M: Diseases of the musculoskeletal system and connective tissueEdit

N: Diseases of the urogenital systemEdit

Q: Congenital malformations, deformations and chromosomal abnormalitiesEdit

T: External causesEdit

CausesEdit

|CitationClass=web }}</ref><ref name="Carr2020">Template:Cite journal</ref> Fistulas to the anus may occur in hidradenitis suppurativa.<ref name="JemecRevuz2006">Template:Cite book</ref> In women, fistulas can also occur following pelvic infection and inflammation.<ref name="UCLA"/>

File:Probed gastrocutaneous fistula tract.jpg
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.<ref name="Crespi Montecamozzo Foschi 2021 p. ">Template:Cite journal</ref> As well as being congenital or resulting from trauma, arteriovenous fistulas are created purposefully for hemodialysis.<ref name=Mayo/> Radiation therapy to the pelvis can lead to vesicovaginal fistulas.<ref name="UCLA"/> Persistent gastrocutaneous fistulas can develop after gastrostomy.<ref>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</ref>
  • 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.<ref name="UCLA"/> 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.<ref>{{#invoke:citation/CS1|citation

|CitationClass=web }}</ref><ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> 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.<ref>Emily Wax, Washington Post Foreign Service. Saturday, October 25, 2003; Page A01 "A Brutal Legacy of Congo War"</ref> Head trauma can lead to perilymph fistulas, whereas trauma to other parts of the body can cause arteriovenous fistulas.<ref name="Nagpal Ahmed Cuschieri 2021 p. ">Template:Cite journal</ref>

TreatmentEdit

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.<ref name="NAFC"/>

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).<ref name="Golub 1997 pp. 487–491">Template:Cite journal</ref>

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 useEdit

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.Template: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.Template:Citation needed

EpidemiologyEdit

Globally, every year between 50,000 and 100,000 women are affected by fistula relating to childbirth.<ref name="WHO2018">{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>

BotanyEdit

In botany, the term is most common in its adjectival forms, where it is used in binomial names to refer to species that are distinguished by hollow or tubular structures. Monarda fistulosa, for example, has tubular flowers;<ref name=Lamiaceae/> Eutrochium fistulosum has a tubular stem; Allium fistulosum has hollow or tubular leaves, and Acacia seyal subsp. fistula is the subspecies with hollow spines.Template:Citation needed

Society and cultureEdit

The term was first used in the 14th century.<ref name=Webster/>

A fistula plays a central role in William Shakespeares play All's Well That Ends Well

See alsoEdit

ReferencesEdit

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External linksEdit

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