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Gastrointestinal fistula

Definition

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

  • Leaks that go through to a part of the intestines are called entero-enteral fistulas.
  • Leaks that go through to the skin are called enterocutaneous fistulas.
  • Other organs can be involved, such as the bladder, vagina, anus, and colon.

Alternative Names

Entero-enteral fistula; Enterocutaneous fistula; Fistula - gastrointestinal

Causes

Most gastrointestinal fistulas occur after surgery. Other causes include:

  • Blockage in the intestine
  • Infection
  • Crohn disease
  • Radiation to the abdomen (most often given as part of cancer treatment)
  • Injury, such as deep wounds from stabbing or gunshot
  • Swallowing caustic substances (such as lye)

Symptoms

Depending on where the leak is, these fistulas may cause diarrhea, and poor absorption of nutrients. Your body may not have as much water and fluids as it needs.

  • Some fistulas may have no symptoms.
  • Other fistulas cause intestinal contents to leak through an opening in the skin.

Exams and Tests

Tests may include:

  • Barium swallow to look in the stomach or small bowel
  • Barium enema to look in the colon
  • CT scan of the abdomen to look for fistulas between loops of the intestines or areas of infection
  • Fistulogram, in which contrast dye is injected into the opening of the skin of a fistula and x-rays are taken

Treatment

Treatments may include:

  • Antibiotics
  • Immune suppressing medicines if the fistula is a result of Crohn disease
  • Surgery to remove the fistula and part of the intestines if the fistula is not healing
  • Nutrition through a vein while the fistula heals (in some cases)

Some fistulas close on their own after a few weeks to months.

Outlook (Prognosis)

The outlook depends on the person's overall health and how bad the fistula is. People who are otherwise healthy have a very good chance of recovery.

Possible Complications

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

When to Contact a Medical Professional

Call your health care provider if you have:

  • Very bad diarrhea or other major change in bowel habits
  • Leakage of fluid from an opening on the abdomen or near the anus, especially if you have recently had abdominal surgery

References

De Prisco G, Celinski S, Spak CW. Abdominal abscesses and gastrointestinal fistuals. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 28.

Lichtenstein GR. Inflammatory bowel disease. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 141.

Nandakumar G, Michelassi F. Crohn disease. In: Yeo CJ, ed. Shackleford's Surgery of the Alimentary Tract. 7th ed. Philadelphia, PA: Elsevier Saunders; 2013:chap 71.

Review Date:5/11/2016
Reviewed By:Subodh K. Lal, MD, gastroenterologist with Gastrointestinal Specialists of Georgia, Austell, GA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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