Gastrointestinal fistula

• Alternative Names

  Entero-enteral fistula; Enterocutaneous fistula; Fistula - gastrointestinal

• Causes, incidence, and risk factors

  Most gastrointestinal fisulas are the result of surgery. Other causes include:

  • Inflammatory processes, such as infection or inflammatory bowel disease (Crohn's disease or ulcerative colitis)
  • Trauma, especially penetrating wounds such as those due to a stabbing or gunshot
• Symptoms

  Depending on the part of intestine that are connected, 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

  A gastointestinal fistula can often be identified with a barium swallow test.

  If the fistula involves the colon, a barium enema may be needed.

  A CT scan of the abdomen is usually done to determine if there is an area of infection (abscess) associated with the fistula.

  A fistulogram may also be done. This image test involves injecting contrast dye into the opening of the skin of an enterocutaneous fistula and then taking x-rays.

• Treatment

  Most 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 part of intestine.

• 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.

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

Review Date: 11/17/2008

Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; George F. Longstreth, MD, Department of Gastroenterology, Kaiser Permanente Medical Care Program, San Diego, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.