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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 gastrointestinal tract
  • Infection
  • Inflammatory bowel disease (most often Crohn's disease)
  • Radiation to the abdomen (most often given as part of cancer treatment)
  • Injury such as deep wounds from stabbing or gunshot

Symptoms

Depending on where the leak is, gastrointestinal fistulas may cause diarrhea, malabsorption of nutrients, and dehydration.

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

Exams and Tests


  • Barium swallow to look for a gastrointestinal fistula
  • Barium enema to look for a fistula involving 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 an enterocutaneous fistula and x-rays are taken

Treatment

Treatments may include:

  • Antibiotics
  • Immune suppressing medicines if the fistula is a result of Crohn's 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

Lichtenstein GR. Inflammatory bowel disease. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 143.

Review Date:5/15/2014
Reviewed By:Jenifer K. Lehrer, MD, Department of Gastroenterology, Frankford-Torresdale Hospital, Aria Health System, Philadelphia, PA. 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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