Gastrointestinal fistula

Alternative names
Entero-enteral or enterocutaneous fistula

Definition
Entero-enteral or enterocutaneous fistula is an abnormal passage that leaks the contents of the stomach or the intestine (small or large bowel) to other organs, usually other parts of the intestine (entero-enteral) or the skin (enterocutaneous).

Causes, incidence, and risk factors
The majority of entero-enteral or enterocutaneous fistulas are the result of surgery. A significant minority result from trauma, especially penetrating traumas such as stab wounds or gunshot wounds. Inflammatory processes, such as infection or inflammatory bowel disease (Crohn’s disease), may also cause fistulas.

Symptoms
Entero-enteral fistulas may have no symptoms. Depending on the segments of intestine that are connected, fistulas may cause diarrhea, malabsorption of nutrients, and dehydration. Enterocutaneous fistulas cause leakage of intestinal contents through an opening in the skin.

Signs and tests

A contrast swallow study, in which a radio-opaque dye is swallowed by the patient and x-rays taken, often shows the anatomy of the fistula. If the fistula involves the colon, a contrast enema (contrast dye given through the rectum) may be useful.

A CT scan of the abdomen is usually obtained to determine if an abscess - a walled-off pocket of infection - is associated with the fistula.

A “fistulogram,” in which radio-opaque dye is injected into the opening of the skin of an enterocutaneous fistula and x-rays taken, is often performed as well.

Treatment
Most fistulas will close on their own after a period of weeks to months. Depending on the clinical situation, patients may require IV nutrition and a period of time without food to allow the fistula time to close. In some cases, surgery is necessary to remove the segment of intestine if the fistula is not healing.

Expectations (prognosis)
The prognosis depends on the cause and severity of the fistula and the overall condition of the patient. In most cases, the prognosis is excellent in an otherwise healthy patient.

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. If you have any leakage of fluid that seems to come from the intestines or stomach, or from anywhere on the skin, especially if you have recently had abdominal surgery, call your provider.

Johns Hopkins patient information

Last revised: December 7, 2012
by Sharon M. Smith, M.D.

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