Fistula treatment

Fistula treatment

A fistula is an abnormal connection in the form of a canal that forms between two organs or blood vessels or between one of the body and skin cavities, and the formation of the fistula sometimes begins as an abscess (English: Abscess) i.e. a pocket full of pus inside the body, filled with body fluids continuously Like urine and feces , which in turn prevents the healing of the boil, and in the end the boil makes its way to the skin, organ, or body cavity, forming what is known as a fistula.  Symptoms vary according to the location and severity of the fistula . Symptoms may include: pain, fever, itching, nausea, vomiting, diarrhea, feeling of general weakness, in addition to pus coming out, or bad smelling secretions , leaking urine or stool, Or gases to the vagina. 
It is worth noting that fistula may be at some from birth, and may result from other causes such as: complications of surgeries, infections and childbirth, and difficult obstetrics (in English: Obstructed Labor). This may result because of medical conditions such as Crohn 's disease ( in English: Chrons Disease), ulcerative colitis ( in English: Ulcerative Colitis), in addition to that people who are undergoing radiation treatment at risk of multiple types of fistula. There is what is known as an artificial fistula, such as a fistula designed between an artery and a vein to produce what is called an arteriovenous fistula (for those who need dialysis ) (English: Renal Dialysis). 

Types of fistula

Fistula is classified into the following types according to the number of openings and its connection to internal organs or its exit from the skin: [1] [5]
  • Locked fistula: (English: blind fistula) is open from one side only and closed from the other side, and it can turn into a complete fistula if it is not treated.
  • The complete fistula (in English: complete fistula) has an internal opening and an external opening.
  • Incomplete fistula: channels in the skin are open from the outside, but they are closed from the inside, and do not connect with any internal structure.
  • Horseshoe fistula is a complex U-shaped type in English that connects two external openings on both sides of the anus.

Fistula can appear in any part of the body, but it is more prevalent in the digestive system , and can also form between two blood vessels, the urinary system, the reproductive system, and the lymphatic system , and examples of fistulas that can occur in Various parts of the body:
  • Anal fistula rectal: (English: Anorectal Fistula), which connects the anal canal and the skin surrounding the anus, it is worth mentioning that the anal fistula affects men by more women.
  • Intestinal fistula: (Enteroenteral Fistula): It connects two parts of the intestine.
  • Skin intestinal fistula: (Enterocutaneous) and connects the small intestine and skin.
  • Skin coli fistula: (Colocutaneous), which links the colon and the skin.
  • Tracheal fistula esophagus: Tracheoesophageal fistulas (Trachea) and esophagus (English: esophagus), often due to a birth defect from birth that allows air to enter the digestive system and food to enter the lungs.
  • Vaginal fistula: (Vesicovaginal fistula) Connects the vagina and the bladder, causing urine to leak out of the vagina, as well as frequent infections of the bladder and vagina.
  • Vaginal fistula intestinal: (English: enterovaginal fistula) connects between the vagina and the large intestine and leads to leaking feces from the vagina.
  • Vaginal fistula Urethral: (English: Urethrovaginal fistula) connects between the urethra and vagina.
  • Arteriovenous fistula (English: Arteriovenous fistulas) It consists between an artery containing oxygen-laden blood for all parts of the body and a vein that is laden with blood returning to the lung, resulting in abnormal blood pressure and blood flow.

Fistula treatment

The specialist determines the treatment plan that is best suited for a fistula based on its location, size and condition. Treatments are divided into two main parts as follows:
Non-surgical treatment It includes the following options:
  • Catheterization: In catheterization, it is used in the case of a relatively small fistula to treat infection by draining the pus present in the fistula, as in the anal or rectal fistula. [3] [5]
  •  Drug therapy: Antibiotics are used to treat infections associated with fistula, and infliximab can be used to reduce inflammation and help heal the rectal vaginal fistula (Rectovaginal fistula) in women with Crohn's disease . [3] [6]
  •  Food intestinal: (English: Enteral diet) , a liquid containing food on important nutrients that are taken by mouth or given through a feeding tube, and given instead of solid food; so as to minimize the amount of feces outside of the anus, and thus to help heal the fistula and close . This treatment can be used in case of intestinal vaginal fistula, intestinal cutaneous fistula, and enterovesic fistula (English: Enterovesicular fistulas).
  •   Adhesive fibrin: (English: Fibrin glue) is a medical adhesive material is injected into the fistula channel to close tightly, then is stitched slot fistula is a way easy, safe and painless, but the results are weak in the long term. [3] [7] Laser therapy ( in English: Laser therapy) uses a laser to get rid of arterial venous fistula congenital ( in English: Congenital arteriovenous fistulas) with relative ease if the small size.
  •  Pressure directed ultrasonic: (English: Ultrasound-guided compression) is used in the case of fistula arterial venous existing in the leg area if it was visible on the ultrasound device; depends on where the ultrasound pressure on the fistula, and the closure of the blood flow of blood vessels damaged . 
  •  Seal: (Plug: English) This plug is often made of collagen diaphragm and fills the fistula. 

Surgical treatment

Fistula treatment is done surgically, either through the incision of the abdominal wall, or by making a small incision and the use of a camera and small tools to deal with the fistula, using laparoscopic surgery technology. 

The surgical treatment method includes the following steps:

  • Careful examination to determine the pathway of the fistula through the tissues: using special shades (Contrast dyes) and imaging.
  •  Emptying and discharging the accumulated pus in the fistula: ensuring the integrity of the tissue surrounding the fistula, and that it is free from infection or inflammation.
  •  Surgical removal of the fistula: which is called fistulotomy (used in fistulotomy) and used in 85-95% of cases, where an incision is made over the entire length of the fistula, then discharged from the contents, paved and kept in its new location until it heals and recovers.
The surgery includes the following options to complete it:

  • Seton stitch: This stitch is produced by passing a thread through the fistula to make a knot that connects it outside, leaving a way to drain and empty.
  •  Action flap soles of the rectum: (English: Endorectal flap) used in the case of fistula Rectal to stitch an alternate Seaton, including the withdrawal of intact tissue over the inner part of the fistula to prevent feces and other substances from causing infections of the channel again. 
  • Vibrin tape: previously mentioned within non-surgical treatments, or a seal made of biological materials (in English: Bioprosthetic plug), and conical shape is made from the tissues of the human body, and is used to close the internal opening of the fistula and it is fixed with stitches, and it is worth noting that it does not close The fistula is sealed to enable the drainage process, and then new tissue grows around the plug to heal the fistula and be treated.


  1. ^ A b t w Sally 's Robertson (11-2-2015), "What ' Is of a Fistula?" , The , Retrieved 18-9-2017. Edited.
  2. ^ A b T. of Amber J. Tresca (7-7-2017), "Fistula Types, Diagnosis, Treatment, And Prognosis" , , Retrieved 18-9-2017. Edited.
  3. ^ A b t w c h x d y "WHAT IS A FISTULA?" , , Retrieved 18-9-2017. Edited.
  4. ↑ "Fistulas" , , 18-10-2016, Retrieved 9-18-2017. Edited.
  5. ^ A b v "Fistula" , , Retrieved 18-9-2017. Edited.
  6. ^ A b Mayo Clinic Staff (17-10-2015), "Rectovaginal fistula" , , Retrieved 9-18-2017. Edited.
  7. ^ A b Rob Hicks (13-9-2017), "Anal fistula" , , Retrieved 18-9-2017. Edited.
  8. ↑ Mayo Clinic Staff (7-4-2015), "Arteriovenous fistula" , , Retrieved 18-9-2017. Edited.
  9. ^ A b Ananya Mandal (11/17/2013), "Fistula Treatment" , , Retrieved 18-9-2017. Edited.

Fistula treatment