Last updated: August 29, 2023

Summarytoggle arrow icon

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."

Intestinal fistulastoggle arrow icon

Enteroenteric fistula

Enterocutaneous fistula

Optimized nutritional support is associated with higher fistula closure rates and lower mortality. [6]

Enterovesical fistula

Rectovaginal fistula

Biliary-enteric fistulastoggle arrow icon

Cholecystoenteric fistula [11][12][13]

Choledochoduodenal fistula [19]

Pancreatic fistulatoggle arrow icon

Urogenital fistulastoggle arrow icon

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
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

Referencestoggle arrow icon

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  2. Woods RJ, Lavery IC, Fazio VW, Jagelman DG, Weakley FL. Internal fistulas in diverticular disease.. Dis Colon Rectum. 1988; 31 (8): p.591-6.doi: 10.1007/BF02556792 . | Open in Read by QxMD
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  4. Ahmad DS, Quist EE, Hutchins GF, Bhat I. Coloenteric fistula in a young patient with recurrent diverticulitis: A case report and review of the literature.. Neth J Med. 2016; 74 (8): p.358-261.
  5. Lynch AC, Delaney CP, Senagore AJ, Connor JT, Remzi FH, Fazio VW. Clinical outcome and factors predictive of recurrence after enterocutaneous fistula surgery.. Ann Surg. 2004; 240 (5): p.825-31.doi: 10.1097/01.sla.0000143895.17811.e3 . | Open in Read by QxMD
  6. Gribovskaja-Rupp I, Melton G. Enterocutaneous Fistula: Proven Strategies and Updates. Clinics in Colon and Rectal Surgery. 2016; 29 (02): p.130-137.doi: 10.1055/s-0036-1580732 . | Open in Read by QxMD
  7. Fischer JE, Bland KI. Mastery of Surgery. Lippincott Williams & Wilkins ; 2006
  8. Haack CI, Galloway JR, Srinivasan J. Enterocutaneous Fistulas: A Look at Causes and Management. Current Surgery Reports. 2014; 2 (10).doi: 10.1007/s40137-014-0071-0 . | Open in Read by QxMD
  9. Golabek T, Szymanska A, Szopinski T, et al. Enterovesical fistulae: aetiology, imaging, and management.. Gastroenterology research and practice. 2013; 2013: p.617967.doi: 10.1155/2013/617967 . | Open in Read by QxMD
  10. Raymond PL, Gibler WB. Detection of colovesical fistula in the emergency department: report of a case.. Am J Emerg Med. 1989; 7 (2): p.191-5.doi: 10.1016/0735-6757(89)90137-x . | Open in Read by QxMD
  11. Smith EA, Dillman JR, Elsayes KM, Menias CO, Bude RO. Cross-Sectional Imaging of Acute and Chronic Gallbladder Inflammatory Disease. American Journal of Roentgenology. 2009; 192 (1): p.188-196.doi: 10.2214/ajr.07.3803 . | Open in Read by QxMD
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  20. Bassi C, Dervenis C, Butturini G, et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition.. Surgery. 2005; 138 (1): p.8-13.doi: 10.1016/j.surg.2005.05.001 . | Open in Read by QxMD
  21. Alexakis N, Sutton R, Neoptolemos JP. Surgical treatment of pancreatic fistula.. Dig Surg. 2004; 21 (4): p.262-74.doi: 10.1159/000080199 . | Open in Read by QxMD

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