Intestinal fistula

Intestinal fistula is a hole in the wall of the intestine that connects its cavity surface of the body (external intestinal fistula) or hollow organ (internal intestinal fistula). Intestinal fistulas can be congenital or caused damage to the intestine at the closed trauma, as well as penetrating wound in the stomach cutting, any sharp, firearms; if the damage is in the bowel wall from the inside of foreign bodies; if the perforation of the intestinal ulcers. Intestinal fistula may occur and result in necrosis of the intestinal wall due to local vascular disorders.

intestinal fistula
Fig. 1. Intestinal fistula (scheme): 1 - full gubbey, intestinal contents stands out (arrow); 2 - incomplete gubbey, intestinal contents partially transformed into elbow to the gut (arrow); 3 - tube long fistulous swing.

Artificial external intestinal fistula are often impose with the medical purpose for nutritional [for example, burns, or tumors of the stomach (see Enterostomy)] or for a temporary discharge of the intestine in intestinal obstruction, peritonitis.
Intestinal fistula is divided into Goloviznin (complete and incomplete), in which the mucous membrane of the colon is fused with the edge of the skin (Fig. 1.1 and 2), and tubular when a defect in the intestine is not attached to the skin, and is connected to it through channels (Fig. 1,3).
Intestinal fistulas are multiple, holes they can be of different size, location and form. Typical external intestinal fistula is the allocation outside the intestinal contents and emissions.


Fig. 2. Skin treatment and application of protective ointment around the fistula: 1 - leather processing and destruction of intestinal contents from the surface; 2 - the imposition of protective cream.

At high fistula small intestine detachable contains maloperverso food with significant admixture of bile; around the fistula is usually seen significant changes skin dermatitis. To protect your skin, it is covered with a thick layer 2% zinc ointment, pastes of Lassara (Fig. 2), a mixture of clay with tannin and other Under a bandage dermatitis proceed much heavier, and therefore patients should be open fistula under the frame. The state of such patients is compounded by a significant loss from the intestinal discharge of nutrients and fluids; quickly comes exhaustion, dehydration, intoxication. To avoid this, you intravenously or subcutaneously to enter from two to three liters saline solution, 5% solution of glucose, vitamins. Great importance is the transfusion of blood substitutes and protein (see Blood liquids).
For the temporary closure of intestinal fistula apply different obturators that mechanical stop the intake of intestinal contents out. Goloviznin fistula spontaneously not closed and their presence is an indication for surgery. Tubular fistula result in scarring of the channel, as a rule, are closed independently.
When intestinal fistula lower parts of the small intestine and especially of the colon allocate less irritating and care it does not represent special work. The diet of patients is not limited. Patients with fistula colon cancer can be treated as outpatients. If intestinal fistula colon is not closed within 6-7 months, showing surgery. The exception is artificial intestinal fistula, imposed with the medical purpose. Terms of closing shall be specially indicated.