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Gastrointestinal fistula

Definition

A gastrointestinal fistula is an abnormal opening that allows the contents of the stomach or intestines to leak.

• If it leaks through to a part of the intestines, it is called an entero-enteral fistula.
• If it leaks to through to the skin, it is called an enterocutaneous fistula.

Alternative Names

Entero-enteral fistula; Enterocutaneous fistula; Fistula - gastrointestinal

Causes, incidence, and risk factors

Most gastrointestinal fistulas occur after surgery. Other causes include:

• Gastrointestinal obstruction
• Inflammatory processes, such as infection or inflammatory bowel disease (most often Crohn's disease)
• Radiation to the abdomen (most often given as part of cancer treatment)
• Trauma, especially penetrating wounds such as those due to a stabbing or gunshot

Symptoms

Depending on the part of the intestines that are leaking, gastrointestinal fistulas may cause diarrhea, malabsorption of nutrients, and dehydration.

• Entero-enteral fistulas may have no symptoms.
• Enterocutaneous fistulas cause leakage of intestinal contents through an opening in the skin.

Signs and tests

• Barium swallow (to identify a gastrointestinal fistula)
• Barium enema (to identify a fistula involving the colon)
• CT scan of the abdomen (to identify fistulas between loops of the intestines or an area of infection, called an abscess, associated with the fistula)
• Fistulogram (involves injecting contrast dye into the opening of the skin of an enterocutaneous fistula and then taking x-rays)

Treatment

Some fistulas close on their own after a few weeks to months. Depending on the situation, some people may need to receive nutrition through a vein while the fistula heals.

In some cases where the fistula is not healing, surgery is necessary to remove the fistula and part of the intestines.

Support Groups

Expectations (prognosis)

How well a patient does depends on their overall health and the cause and severity of the fistula. In otherwise healthy people, the outlook is excellent.

Complications

Fistulas may result in malnutrition and dehydration, depending on their location in the intestine. They may also be a source of skin problems and infection.

Calling your health care provider

Call your health care provider if you have a significant change in bowel habits, especially severe diarrhea. Also call if you have any leakage of fluid from an opening on the abdomen or near the anus, especially if you have recently had abdominal surgery.

Prevention

References

Stenson WF. Inflammatory bowel disease. In: Goldman L, Ausiello D, eds. . 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 144.