Fistula
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In medicine, a '''fistula''' (pl. fistulas or fistulae) is an abnormal connection or passageway between two [[epithelium]]-lined organs or vessels that normally do not connect.
==Location of fistulas==
Fistulas can develop in various parts of the body. The following list is sorted by the [[ICD|International Statistical Classification of Diseases and Related Health Problems]].
===H: Diseases of the eye, adnexa, ear, and mastoid process===
*(H04.6) [[Lacrimal fistula]]
*(H70.1) [[Mastoid fistula]]
**[[Craniosinus fistula]]: between the [[intracranial space]] and a [[paranasal sinus]]
*(H83.1) [[Labyrinthine fistula]]
**[[Perilymph fistula]]: tear between the membranes between the middle and inner [[ears]]
===I: Diseases of the circulatory system===
*(I25.4) [[Coronary arteriovenous fistula]], acquired
*(I28.0) [[Arteriovenous fistula]] of [[pulmonary vessels]]
**[[Pulmonary arteriovenous fistula]]: between an artery and vein of the [[lungs]], resulting in [[shunting]] of [[blood]]. This results in improperly oxygenated blood.
*(I67.1) Cerebral [[arteriovenous fistula]], acquired
*(I77.0) [[Arteriovenous fistula]], acquired
*(I77.2) Fistula of [[artery]]
===J: Diseases of the respiratory system===
*(J86.0) [[Pyothorax]] with fistula
*(J95.0) [[Tracheoesophageal fistula]] following [[tracheostomy]]: between the breathing and the feeding tubes
===K: Diseases of the digestive system===
[[Image:Duodeno Biliary Fistula 08786.jpg|thumb|Duodeno Biliary Fistula]]
*(K11.4) Fistula of [[salivary gland]]
*(K31.6) Fistula of [[stomach]] and [[duodenum]]
*(K31.6) [[Gastrocolic fistula]]
*(K31.6) [[Gastrojejunocolic fistula ]]
**[[Enterocutaneous fistula]]: between the intestine and the skin surface, namely from the [[duodenum]] or the [[jejunum]] or the [[ileum]]. This definition excludes the fistulas arising from the [[Colon (anatomy)|colon]] or the [[appendix]].
**[[Gastric fistula]]: from the [[stomach]] to the skin surface
*(K38.3) [[Fistula of appendix]]
*({{ICD10|K|60|3|k|55}}) [[Anal fistula]]
**({{ICD10|K|60|3|k|55}}) [[Anorectal fistula]]: connecting the [[rectum]] or other [[anorectal]] area to the [[skin]] surface. This results in abnormal discharge of [[feces]] through an opening other than the [[anus]]. Also called '''fistula-in-ano'''.
***'''Fecal fistula''': see Anorectal
***'''Fistula-in-ano''': see Anorectal
*({{ICD10|K|60|4|k|55}}) [[Rectal fistula]]
*({{ICD10|K|60|5|k|55}}) [[Anorectal fistula]]
*(K63.2) Fistula of [[intestine]]
**[[Enteroenteral fistula]]: between two parts of the [[intestine]]
*(K82.3) Fistula of [[gallbladder]]
*(K83.3) Fistula of [[bile duct]]
**[[Biliary fistula]]: connecting the [[bile]] ducts to the skin surface, often caused by [[gallbladder]] surgery
**[[Pancreatic fistula]]: between the [[pancreas]] and the exterior via the [[abdominal wall]]
===M: Diseases of the musculoskeletal system and connective tissue===
*(M25.1) Fistula of [[joint]]
===N: Diseases of the genitourinary system===
*(N32.1) [[Vesicointestinal fistula]]
*(N36.0) [[Urethral fistula]]
**[[Innora]]:between the [[prostatic utricle]] and the outside of the body
*(N64.0) [[Fistula of nipple]]
*(N82) [[Fistulae involving female genital tract]] / [[Obstetric fistula]]
**(N82.0) [[Vesicovaginal fistula]]: between the [[Urinary bladder|bladder]] and the [[vagina]]
**(N82.1) Other [[female urinary-genital tract fistulae]]
***'''[[Cervical fistula]]: abnormal opening in the [[cervix]]
**(N82.2) [[Fistula of vagina to small intestine]]
***[[Enterovaginal fistula]]: between the [[intestine]] and the [[vagina]]
**(N82.3) [[Fistula of vagina to large intestine]]
***[[Rectovaginal fistula|Rectovaginal]]: between the [[rectum]] and the [[vagina]]
**(N82.4) Other [[female intestinal-genital tract fistulae]]
**(N82.5) [[Female genital tract-skin fistulae]]
**(N82.8) Other [[female genital tract fistulae]]
**(N82.9) [[Female genital tract fistula]], unspecified
===Q: Congenital malformations, deformations and chromosomal abnormalities===
*(Q18.0) [[Sinus (anatomy)|Sinus]], fistula and [[cyst]] of [[branchial cleft]]
**[[Congenital]] Preauricular fistula: A small pit in front of the [[ear]]. Also called Fistula Auris Congenita or [[Ear Pit]].
*(Q26.6) [[Portal vein]]-[[hepatic artery]] fistula
*(Q38.0) [[Congenital]] fistula of [[lip]]
*(Q38.4) [[Congenital]] fistula of [[salivary gland]]
*(Q42.0) [[Congenital]] [[absence]], [[atresia]] and [[stenosis]] of [[rectum]] with fistula
*(Q42.2) [[Congenital]] [[absence]], [[atresia]] and [[stenosis]] of [[anus]] with fistula
*(Q43.6) [[Congenital]] fistula of [[rectum]] and [[anus]]
*(Q51.7) [[Congenital]] fistulae between [[uterus]] and [[digestive]] and [[urinary tracts]]
*(Q52.2) [[Congenital]] [[rectovaginal fistula]]
===T: External causes===
*(T14.5) [[Traumatic arteriovenous fistula]]
*(T81.8) [[Persistent postoperative fistula]]
==Types of fistulas==
Various types of fistulas include:
*'''Blind''': with only one open end
*'''Complete''': with both external and internal openings
*'''Incomplete''': a fistula with an external skin opening, which does not connect to any internal organ
Although most fistulas are in forms of a tube, some can also have multiple branches.
==Causes==
Various causes of fistula are:
*'''Diseases''': Inflammatory bowel diseases, such as [[Crohn's disease]] and [[ulcerative colitis]], are the leading causes of anorectal, enteroenteral, and enterocutaneous fistulas. A person with severe stage-3 [[hidradenitis suppurativa]] will also develop fistulas.
*'''Medical treatment''': Complications from gallbladder surgery can lead to biliary fistula. Radiation therapy can lead to vesicovaginal fistula. An arteriovenous fistula can be deliberately created, as described below in ''therapeutic use''.
*'''Trauma''': Head trauma can lead to [[perilymph fistula]]s, whereas trauma to other parts of the body can cause arteriovenous fistulas. Obstructed labor can lead to vesicovaginal and rectovaginal fistulas. An [[obstetric fistula]] develops when blood supply to the tissues of the vagina and the bladder (and/or rectum) is cut off during prolonged obstructed labor. The tissues die and a hole forms through which urine and/or feces pass uncontrollably. [[vesicovaginal fistula|Vesicovaginal]] and [[rectovaginal fistula]]s may also be caused by rape, in particular gang rape, and rape with foreign objects, as evidenced by the abnormally high number of women in conflict areas who have suffered fistulae.<ref>[http://www.msmagazine.com/spring2005/congo.asp Stephanie Nolen, "Not Women Anymore…" Ms. Magazine, Spring 2005]</ref><ref>[http://www.unfpa.org/news/news.cfm?ID=816 UNFPA: United Nations Population Fund. Press Release, 22 June 2006. "More Funding Needed to Help Victims of Sexual Violence"]</ref>
* In 2003, thousands of women in eastern Congo presented themselves for treatment of traumatic fistula caused by systematic, violent gang rape that occurred during the country's five years of war. So many cases have been reported that the destruction of the vagina is considered a war injury and recorded by doctors as a crime of combat.<ref>[http://www.washingtonpost.com/ac2/wp-dyn/A14059-2003Oct24 Emily Wax, Washington Post Foreign Service. Saturday, October 25, 2003; Page A01 "A Brutal Legacy of Congo War"]</ref>
== Treatment ==
Treatment for fistulae varies depending on the cause and extent of the fistula, but often involves surgical intervention combined with [[antibiotic]] therapy.
Typically the first step in treating a fistula is an examination by a doctor to determine the extent and "path" that the fistula takes through the tissue.
In some cases the fistula is temporarily covered, for example a fistula caused by [[cleft lip and palate|cleft palate]] is often treated with a [[palatal obturator]] to delay the need for surgery to a more appropriate age.
Surgery is often required to assure adequate drainage of the fistula (so that [[pus]] may escape without forming an [[abscess]]). Various surgical procedures are commonly used, most commonly [[fistulotomy]], placement of a [[Seton stitch|seton]] (a cord that is passed through the path of the fistula to keep it open for draining), or an endorectal flap procedure (where healthy tissue is pulled over the internal side of the fistula to keep feces or other material from reinfecting the channel). Treatments involving filling the fistula with fibrin glue or plugging it with plugs made of porcine small intestine submucosa have also been explored in recent years, with variable success. Surgery for anorectal fistulae is not without side effects, including recurrence, reinfection, and incontinence.
It is important to note that surgical treatment of a fistula without diagnosis or management of the underlying condition, if any, is not recommended. For example, surgical treatment of fistulae in [[Crohn's disease]] can be effective, but if the Crohn's disease itself is not treated, the rate of recurrence of fistula is very high (well above 50%).
== Therapeutic use ==
In [[end stage renal failure]] patients, a [[cimino fistula]] is often deliberately created in the arm by means of a short day surgery in order to permit easier withdrawal of blood for [[hemodialysis]].
As a radical treatment for [[portal hypertension]], surgical creation of a portacaval fistula produces an anastomosis between the [[hepatic portal vein]] and the [[inferior vena cava]] across the omental foramen (of Winslow). This spares the portal venous system from high pressure which can cause esophageal varices, caput madusae, and hemorrhoids.
== See also ==
* [[Anastomosis]]
== References ==
{{Reflist}}
== External links ==
* [http://www.endfistula.org Campaign to End Fistula]
* [http://www.clevelandclinic.org/colorectal/pinfo_fistula.htm Cleveland Clinic - Anorectal Fistula]
* [http://www.hemorrhoidsinplainenglish.com/anorectal/fistula.htm Hemorrhoids In Plain English - Fistula-in-Ano]
* [http://www.mayoclinic.com/invoke.cfm?id=HQ00263 Mayo Clinic - Arteriovenous Fistula]
* [http://urologyhealth.org/adult/index.cfm?cat=03&topic=35 American Urological Association - Bladder Fistula]
* [http://www.american-hearing.org/name/perilymph_fistula.html%20 American Hearing Research Foundation - Perilymph Fistula]
* [http://www.urotoday.com/browse_categories/urologic_trauma_and_reconstruction/fistula.html Urinary Fistula]
* [http://www.way2ayurveda.com/fistulainano/index.html Fistula]
* [http://www.fistulafoundation.org The Fistula Foundation - Obstetric Fistulas]
* [http://www.fistulahospital.org Fistula Hospital in Ethiopia]
* [http://www.washingtonpost.com/ac2/wp-dyn/A14059-2003Oct24?language=printer Washington Post article] on fistulae in conflict areas in the Democratic Republic of the Congo
* [http://www.msnbc.msn.com/id/15704030/site/newsweek/print/1/displaymode/1098/ “Congo's Wounds of War: More Vicious than Rape”], a Newsweek article on fistulae in conflict areas in the Democratic Republic of the Congo
* [http://www.fightfistula.org/ One by One - Funding Care for Women with Fistula]
* [http://www.panzihospitalbukavu.org/ Panzi Hospital of Bukavu in the Democratic Republic of Congo]
* [http://www.irinnews.org/report.asp?ReportID=50123&SelectRegion=East_Africa SUDAN: Fighting fistula in Khartoum], IRIN, 16 November, 2005
* [http://www.pbs.org/wgbh/nova/beautiful/ NOVA: A Walk to Beautiful], May 18, 2008
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