Fistulas

  • Rectal fistula
  • Treatment for fistula
  • Fistulas (fistula) - pathologically the formed channels connecting the disease site, hollow organs and cavity with the body surface or hollow organs with each other.
    There are external and internal fistula.
    External fistula connect hollow organs, oral or an infection with the surface of the skin (for example, at intestinal fistula the bowel lumen reported to the outside, septic-purulent mastitis cavity through fistulous course drained out).
    Internal fistula connect hollow bodies between themselves or hollow organ and inflammatory focus. Can be congenital (e.g., esophageal-tracheal fistula) or arise in certain pathological processes between the stomach and colon, between thin intestines, etc.
    Origin fistulas may be congenital and acquired.
    Congenital fistulas are the result of fetal malformations. These include the median, bronhogenny (Gill) and lateral neck fistulas, umbilical fistulas and other
    Acquired fistulas are often a complication of diseases of separate organs or systems. They are divided into the following forms fistula: a) inflammatory fistulas occur as a result of inflammation, purulent processes (e.g. osteomyelitis, paraproctitis); b) traumatic fistula - arise because of injury or rupture of hollow organs (for example, intestinal fistula as a result of injury ulcer, urinary fistula due to the damage of the bladder wall of bone fragments in fractures of pelvic bones); postoperative fistulas occur as a result of the postoperative trauma or insolvency imposed joints (for example, duodenal fistula, ureter fistula); d) artificial fistula is created with the purpose of treatment for supply of the patient (gastrostomy tube), to fight with peritonitis and intestinal obstruction (ileostomy, scotoma, SIGMASCOPE), as a possible outcome of the operation (for example, removal of the rectum). Artificial fistulas can be temporary or permanent.
    In structure fistulas are divided into kapitalisierung, granulating, Goloviznin. Kapitalisierung fistula - congenital or acquired; fistulous channel smooth, covered epithelium, alone does not heal. Granulating fistula - acquired; fistulous channel covered with granulations, often heal on their own. Goloviznin fistula - acquired; mucous membrane of a hollow organ goes directly into the skin without fistular channel (Fig.), what hinders self-closing.


    Goloviznin intestinal fistula:
    1 - full; 2 - incomplete. The arrows indicate the direction of movement of the intestinal contents.

    The nature of fistula discharge depends on the pathologic process, causing a fistula or body with which it is connected. For fistulas hollow organs characterized by a selection of content of these bodies (the feces, urine, saliva, mucus from the bronchi and so on). Discharge from the fistula may be purulent or mixed - pus and the secret of the body (for example, chronic pancreatic discharge from pancreatic fistula).
    Clinical course fistula different. Congenital neck fistulas are located on the side or the front surface of the neck. The skin here is the funnel indrawing at the bottom of which offer fistula with constant allocation of a small number of mucous fluid. Esophageal fistula can be localized on the neck and chest; as a rule, are acquired, are characterized by constant allocation of a fistula saliva, and while eating food. Fistulas bowel - see Intestinal fistula.
    The clinical picture of bronchial fistulas varied and depends on its type and diameter. Patients usually concerned about vihodnie air from the fistula coughing and talk and mucopurulent discharge from the fistula, the necessity of frequent changes of dressings, cough when removing the bandages. The skin around the fistula changed, milopotamou that promotes continuous gaping fistula.
    Ascitic fistula sometimes develop as a complication of a puncture of the abdominal wall is made to remove ascitic fluid. Through a needle hole is continuous leakage that can lead to infection of the abdominal cavity and the development of ascites - peritonitis.
    Liquor fistula occurs when the bone defect and the damage Dura mater of brain or spinal cord. Accompanied by constant likwore (see).
    Fistulas urogenital system - see Urinary fistulas.
    Purulent fistula characterized by constant discharge of pus, irritating the skin, causing itching and eczema. Corking holes fistula may exacerbate the process with the formation of cellulitis or abscess.
    Symptoms internal fistula less certain and depend on the specifics of communicating with each other organs. For example, if the fistula between the stomach and large intestine most frequently reported pain in the epigastric region, belching and vomiting with fecal odor, diarrhea emitting undigested food, emaciation.
    Diagnostics of external fistula is not difficult and is based on the characteristic complaints, anamnesis, as fistula, the number and nature of discharge. When internal fistula diagnosis is made on the basis of changes of the function of the affected organ, as well as the results of investigations.
    To determine the nature, depth and channel fistula additional research is needed - fistulography (see), introduction to fistulous the course of radiopaque substance with the subsequent manufacture of x-ray images.