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Fistulas

Last updated: December 30, 2021

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A fistula is an abnormal connection between two epithelium-lined surfaces. The most common fistulas are enteroenteric fistula, enterovesical fistula, rectovaginal fistula, cholecystoenteric fistula, pancreatic fistula, and urogenital fistula. Fistulas are most commonly caused by local inflammation (e.g., diverticulitis, Crohn disease, pancreatitis), malignancy (e.g., colon cancer, rectal cancer), or iatrogenic injury (e.g., resulting from prolonged labor, abdominal or pelvic surgery, radiation). Clinical features depend on the location of the fistula, e.g., enteroenteric, enterovesical, and pancreatic fistulas cause abdominal pain and diarrhea. Some fistulas (e.g., enterovesical, vesicovaginal, rectovaginal, and enterocutaneous fistulas) cause leakage of fluid from the connected organ. Diagnosis for most fistulas is made via abdominal or pelvic CT. Treatment most commonly consists of fistula resection, although conservative management may be indicated for certain fistulas (e.g., choledochoduodenal and pancreatic fistulas).

For more information on vascular fistulas, see “Arteriovenous fistulas;” for more information on tracheoesophageal fistula, see “Esophageal atresia;” and for more information on anal fistulas, see “Anal abscess and fistula."

Enteroenteric fistula

Enterocutaneous fistula

Enterovesical fistula

Rectovaginal fistula

Cholecystoenteric fistula [9][10][11]

Choledochoduodenal fistula [17]

Urogenital fistulas
Characteristics Vesicovaginal fistula Ureterovaginal fistula
Definition
Epidemiology
  • Most commonly occurs in patients from resource-limited countries
  • Associated with decreased access to obstetric emergency services
Etiology
  • Early sexual intercourse
Pathophysiology
  • Development of maternal soft tissue necrosis caused by prolonged compression between the maternal pelvic bones and fetal head → formation of fistulas
Clinical features
  • Painless urinary leakage from the vagina after delivery
  • Frequent UTIs
  • Continuous urine loss after delivery
Diagnostics Vaginal examination
  • A small, erythematous area with no visible opening or opening on visualization
  • Urine leakage or pooling on direct visualization
Double dye test
Other tests

Treatment

  • Surgical repair
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