Last updated: August 17, 2022

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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
  • Most commonly occurs in individuals living in resource-limited countries (esp. sub-Saharan Africa and South Asia)
  • In patients living in resource-rich countries, the most common cause is iatrogenic injury (e.g., bladder injury during hysterectomy).
  • Sexual intercourse at an early age
  • Prolonged compression of soft tissue between the maternal pelvic bones and fetal head → maternal soft tissue pressure necrosis → formation of fistulas
Clinical features
  • Continuous urinary leakage from the vagina after delivery
Diagnostics Vaginal examination
  • A small, erythematous area with an opening that may or may not be visible
  • Urinary leakage or pooling on direct visualization
Double dye test
Other tests


  • Surgical repair
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