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Fistulas

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About

Fistulas are abnormal passages (that start as an abscess) that can open between parts of the intestines, the intestines and the skin (most commonly around the anus), or the intestines and other area of the body such as the vagina or bladder. Over time, approximately 18% - 50% of patients with Crohn's Disease will develop a fistula [1] [2] [3]. They are not commonly seen in Ulcerative Colitis and other forms of IBD. The terminal ileum is the most common location for fistula to form. Some fistula can be completely Asymptomatic whereas others can create major complications.

Fistulas can cause a dangerous form of Arthropathy or Arthritis due to Bacterial Infection of the joints, especially in the Sacroiliac joints.

Types of Fistula

The following are the types of fistula most commonly found with Crohn's Disease:
  • Perianal fistulas
  • Enterocutaneous fistula
  • Enteroenteric fistulas
  • Peristomal fistulas
  • Enterovesical fistulas
  • Enterovaginal fistulas
  • Perineal fistulas

Symptoms

Fistulas can look like boils, or ingrowing hairs around the anus. It may be painful. The patient may notice mucous or stool draining. With a rectovaginal fistula, gas or stool may escape from the vagina. Pads placed in the underwear can help to manage this.

Malabsorption, diarrhea, and weight loss may also result from fistulae.

Causes

There are a variety of causes of fistulae and are categorized as either surgical or spontaneous.[4]

Surgical

- Lysis of adhesions/Enterotomies
- Bowel resection for IBD
- Bowel resection for cancer
- Surgery on radiated bowel
- Unprepped bowel

Spontaneous

- Inflammatory bowel disease
- Diverticular disease
- Ischemic bowel
- Perforated ulcer
- Abdominal penetrating trauma
- Gynecologic malignancies
- Tuberculosis [5]
- HIV/AIDS [5]
- Syphilis [5]
- Chlamydia [5]
- Gonorrhea [6]

Treatment

Biologic drugs (eg Remicade) may help to close fistulas, and keep the Crohn's Disease under control.

Loperamide and codeine can help reduce the output of fistulae.[4]

A type of 'glue' can be used to seal the fistula, and allow the skin to gradually knit together. Or the fistula can be cut out, so the skin can heal normally.

As a fistula closes, infection may become trapped in the tract. Setons (small pieces of thread) can be inserted to allow a fistula to drain, once the fistula is free of infection the seton is removed, hopefully allowing the fistula to heal itself. For more troublesome fistulas, a drain may need to be inserted.

Antibiotics can be given to keep infection under control.

Administration of total parenteral or enteral nutrition has been shown to help induce closure of some fistula.

If a fistula doesn't heal or continues to recur, surgical resection of the affected area may be required. As fistula commonly form in the area just before a stricture due in part to the high pressure of that area, resection of the strictured portion of intestine is common as well.

Fistula Support Group

We have a fistula support forum located here where you can connect with others for support.

References

[pos]1a[/pos][1] http://www.hopkins-gi.org/GDL_Diseas...4-11EC9BF3100E
[pos]2a[/pos][2] Cosnes J, Cattan S, Blain A, et al. Longterm evolution of disease behavior of Crohn’s disease. Inflamm Bowel Dis. 2002; 8: 244–50. http://onlinelibrary.wiley.com/doi/1...7000-00002/pdf
[pos]3a[/pos][3] Nielsen OH, Rogler G, Hahnloser D, Thomsen OO. Diagnosis and management of fistulizing Crohn's disease. Nature Clinical Practice Gastroenterology & Hepatology. 2009; 6: 92-106. Accessed June 2012. http://www.nature.com/nrgastro/journ...sthep1340.html
[pos]4a[/pos][4] http://www.medicine.virginia.edu/cli...ttsArticle.pdf
[pos]5a[/pos][5] http://www.nhs.uk/Conditions/Anal-fi...es/Causes.aspx
[pos]6a[/pos][6] http://www.summitmedicalgroup.com/li.../anal_fistula/

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03-01-2011, 05:23 PM   #1
DustyKat
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Join Date: May 2010
Location: New South Wales, Australia
It can be difficult, when doing a search, to find information that is not related to perianal disease. If you have an intestinal fistula try searching - enterocutaneous fistula crohns disease. You should find some useful information.

Dusty.
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