Fistulas Flashcards
What is a fistula?
Abnormal communication between two hollow organs or a hollow organ and the skin (i.e. 2 epithelial cell layers)
What are the predisposing factors and conditions that maintain latency of a fistula?
HIS FRIEND:
High output fistula (> 500 cc/day); Intestinal destruction (> 50% of circumference); Short segment fistula (< 2.5 cm); Foreign body; Radiation; Infection; Epithelialization; Neoplasm; Distal obstruction
What is an enterocutaneous fistula?
Fistula from GI tract to skin
What are the causes of an enterocutaneous fistula?
Anastomotic leak, trauma to bowel, Crohn’s disease, abscess, diverticulitis, inflammation, infection, inadvertent suture through bowel
What is the workup for enterocutaneous fistula?
CT (rule out abscess or inflammatory process); Fistulagram
What are the possible complications of an enterocutaneous fistula?
High-output fistula; malnutrition; skin breakdown
What is the treatment for an enterocutaneous fistula?
NPO; TPN; drain abscess; rule out and correct underlying causes; may feed distally (or if fistula is distal, feed elemental diet proximally)
Which enterocutaneous fistula closes faster: short or long?
Long fistula
What is a colonic fistula?
Includes colovesical, colocutaneous, colovaginal, and coloenteric fistulas
What are the most common causes of colonic fistula?
Diverticulitis, cancer, IBD, foreign body, radiation
What is the most common type of colonic fistula?
Colovesical: often presents with recurrent UTIs (also pneumaturia, dysuria, fecaluria)
How is the diagnosis of colonic fistula made?
Barium enema; cystoscopy
What is the treatment for colonic fistula?
Segmental colon resection and primary anastomosis.
Repair/resection of the involved organ.
What is a cholecystenteric fistula?
Connection between gallbladder and duodenum or other loop of small bowel due to large gallstone erosion, often resulting in SBO as the gallstone lodges in the ileocecal valve (gallstone ileus)
What are the common causes of a gastrocolic fistula?
Penetrating ulcers, gastric or colonic cancer, Crohn’s disease
What are the possible complications of gastrocolic fistulas?
Malnutrition and severe enteritis due to reflux of colonic contents into the stomach and small bowel with subsequent bacterial overgrowth
What is a pancreatic enteric fistula?
Decompression of a pseudocyst or abscess into an adjacent organ (rare).
Usually done surgically or endoscopically to treat a pancreatic pseudocyst.
What is an external pancreatic fistula?
Pancreaticocutaneous fistula: drainage of pancreatic exocrine secretions through the abdominal skin
What is the treatment for an external pancreatic fistula?
NPO, TPN, skin protection, octreotide
What is a refractory pancreatic fistula?
Pancreaticocutaneous fistula that does not resolve with conservative medical management
What is the diagnostic test for refractory pancreatic fistula?
ERCP to define site of fistula tract
How is refractory tail of a pancreas fistula treated?
Resection of the tail of the pancreas and the fistula
How is refractory head of a pancreas fistula treated?
Pancreaticojejunostomy
What are the specific types of bladder fistulas?
Vesicoenteric: signs include pneumaturia, fecaluria.
Vesicovaginal: signs include urinary leak through vagina.
