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   
. 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
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.
There are a variety of causes of fistulae and are categorized as either surgical or spontaneous.
- Lysis of adhesions/Enterotomies
- Bowel resection for IBD
- Bowel resection for cancer
- Surgery on radiated bowel
- Unprepped bowel
- Inflammatory bowel disease
- Diverticular disease
- Ischemic bowel
- Perforated ulcer
- Abdominal penetrating trauma
- Gynecologic malignancies
- Tuberculosis 
- HIV/AIDS 
- Syphilis 
- Chlamydia 
- Gonorrhea 
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.
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
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