Fistula
Encyclopedia
In medicine, a fistula is an abnormal connection or passageway between two epithelium
-lined organs or vessels that normally do not connect. It is generally a disease condition, but a fistula may be surgically created for therapeutic reasons.
.
Although most fistulas are in forms of a tube, some can also have multiple branches.
therapy.
Typically the first step in treating a fistula is an examination by a doctor to determine the extent and "path" that the fistula takes through the tissue.
In some cases the fistula is temporarily covered, for example a fistula caused by cleft palate is often treated with a palatal obturator
to delay the need for surgery to a more appropriate age.
Surgery is often required to assure adequate drainage of the fistula (so that pus
may escape without forming an abscess
). Various surgical procedures are commonly used, most commonly fistulotomy
, placement of a seton (a cord that is passed through the path of the fistula to keep it open for draining), or an endorectal flap procedure (where healthy tissue is pulled over the internal side of the fistula to keep feces or other material from reinfecting the channel). Treatment involves filling the fistula with fibrin glue; also plugging it with plugs made of porcine small intestine submucosa have also been explored in recent years, with variable success. Surgery for anorectal fistulae is not without side effects, including recurrence, reinfection, and incontinence.
It is important to note that surgical treatment of a fistula without diagnosis or management of the underlying condition, if any, is not recommended. For example, surgical treatment of fistulae in Crohn's disease
can be effective, but if the Crohn's disease itself is not treated, the rate of recurrence of fistula is very high (well above 50%).
is often deliberately created in the arm by means of a short day surgery in order to permit easier withdrawal of blood for hemodialysis
.
As a radical treatment for portal hypertension
, surgical creation of a portacaval fistula produces an anastomosis between the hepatic portal vein
and the inferior vena cava
across the omental foramen (of Winslow). This spares the portal venous system from high pressure which can cause esophageal varices, caput medusae, and hemorrhoids.
Epithelium
Epithelium is one of the four basic types of animal tissue, along with connective tissue, muscle tissue and nervous tissue. Epithelial tissues line the cavities and surfaces of structures throughout the body, and also form many glands. Functions of epithelial cells include secretion, selective...
-lined organs or vessels that normally do not connect. It is generally a disease condition, but a fistula may be surgically created for therapeutic reasons.
Locations
Fistulas can develop in various parts of the body. The following list is sorted by the International Statistical Classification of Diseases and Related Health ProblemsICD
The International Statistical Classification of Diseases and Related Health Problems is a medical classification that provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or disease...
.
H: Diseases of the eye, adnexa, ear, and mastoid process
- (H04.6) Lacrimal fistula
- (H70.1) Mastoid fistula
- Craniosinus fistula: between the intracranial space and a paranasal sinusParanasal sinusParanasal sinuses are a group of four paired air-filled spaces that surround the nasal cavity , above and between the eyes , and behind the ethmoids...
- Craniosinus fistula: between the intracranial space and a paranasal sinus
- (H83.1) Labyrinthine fistula
- Perilymph fistulaPerilymph fistulaA labyrinthine fistula is an abnormal opening in the bony capsule of the inner ear, resulting in leakage of the perilymph from the semicircular canals into the middle ear . This includes specifically a perilymph fistula , an abnormal connection between the fluid of the inner ear and the air-filled...
: tear between the membranes between the middle and inner earsEARSEARS may refer to:* Electoral software* Electronic Arts, Redwood Shores campus.* Emirates Amateur Radio Society...
- Perilymph fistula
- Preauricular fistula
- Preauricular fistula: usually on the top of the cristae helicis earsEARSEARS may refer to:* Electoral software* Electronic Arts, Redwood Shores campus.* Emirates Amateur Radio Society...
- Preauricular fistula: usually on the top of the cristae helicis ears
I: Diseases of the circulatory system
- (I25.4) Coronary arteriovenous fistula, acquired
- (I28.0) Arteriovenous fistulaArteriovenous fistulaAn arteriovenous fistula is an abnormal connection or passageway between an artery and a vein. It may be congenital, surgically created for hemodialysis treatments, or acquired due to pathologic process, such as trauma or erosion of an arterial aneurysm....
of pulmonary vessels- Pulmonary arteriovenous fistula: between an artery and vein of the lungs, resulting in shuntingShuntingShunting is an event in the neuron which occurs when an excitatory postsynaptic potential and an inhibitory postsynaptic potential are occurring close to each other on a dendrite, or are both on the soma of the cell....
of bloodBloodBlood is a specialized bodily fluid in animals that delivers necessary substances such as nutrients and oxygen to the cells and transports metabolic waste products away from those same cells....
. This results in improperly oxygenated blood.
- Pulmonary arteriovenous fistula: between an artery and vein of the lungs, resulting in shunting
- (I67.1) Cerebral arteriovenous fistulaArteriovenous fistulaAn arteriovenous fistula is an abnormal connection or passageway between an artery and a vein. It may be congenital, surgically created for hemodialysis treatments, or acquired due to pathologic process, such as trauma or erosion of an arterial aneurysm....
, acquired - (I77.0) Arteriovenous fistulaArteriovenous fistulaAn arteriovenous fistula is an abnormal connection or passageway between an artery and a vein. It may be congenital, surgically created for hemodialysis treatments, or acquired due to pathologic process, such as trauma or erosion of an arterial aneurysm....
, acquired - (I77.2) Fistula of arteryArteryArteries are blood vessels that carry blood away from the heart. This blood is normally oxygenated, exceptions made for the pulmonary and umbilical arteries....
J: Diseases of the respiratory system
- (J86.0) Pyothorax with fistula
- (J95.0) Tracheoesophageal fistulaTracheoesophageal fistulaA tracheoesophageal fistula is an abnormal connection between the esophagus and the trachea...
, between the tracheaVertebrate tracheaIn tetrapod anatomy the trachea, or windpipe, is a tube that connects the pharynx or larynx to the lungs, allowing the passage of air. It is lined with pseudostratified ciliated columnar epithelium cells with goblet cells that produce mucus...
and the esophagusEsophagusThe esophagus is an organ in vertebrates which consists of a muscular tube through which food passes from the pharynx to the stomach. During swallowing, food passes from the mouth through the pharynx into the esophagus and travels via peristalsis to the stomach...
. This may be congenital or acquired, for example as a complication of a tracheostomy.
K: Diseases of the digestive system
- (K11.4) Fistula of salivary glandSalivary glandThe salivary glands in mammals are exocrine glands, glands with ducts, that produce saliva. They also secrete amylase, an enzyme that breaks down starch into maltose...
- (K31.6) Fistula of stomachStomachThe stomach is a muscular, hollow, dilated part of the alimentary canal which functions as an important organ of the digestive tract in some animals, including vertebrates, echinoderms, insects , and molluscs. It is involved in the second phase of digestion, following mastication .The stomach is...
and duodenumDuodenumThe duodenum is the first section of the small intestine in most higher vertebrates, including mammals, reptiles, and birds. In fish, the divisions of the small intestine are not as clear and the terms anterior intestine or proximal intestine may be used instead of duodenum... - (K31.6) Gastrocolic fistula
- (K31.6) Gastrojejunocolic fistula Gastrojejunocolic fistulaAfter a Billroth II surgical procedure, a gastrojejunocolic fistula may form between the transverse colon and the upper jejunum...
- after a Billroth IIBillroth IIBillroth II, more formally Billroth's operation II, is an operation in which the greater curvature of the stomach is connected to the first part of the jejunum in a side-to-side manner. This often follows resection of the lower part of the stomach . The antrectomy is not part of the orignially...
a fistula forms between the transverse colon and the upper jejunum (which, post Billroth II, is attached to the remainder of the stomach). Fecal matter passes improperly from the colon to the stomach and causes halitosisHalitosisHalitosis is a term used to describe noticeably unpleasant odors exhaled in breathing. Halitosis is estimated to be the third most frequent reason for seeking dental aid, following tooth decay and periodontal disease.- General :...
.- Enterocutaneous fistula: between the intestine and the skin surface, namely from the duodenumDuodenumThe duodenum is the first section of the small intestine in most higher vertebrates, including mammals, reptiles, and birds. In fish, the divisions of the small intestine are not as clear and the terms anterior intestine or proximal intestine may be used instead of duodenum...
or the jejunumJejunumThe jejunum is the middle section of the small intestine in most higher vertebrates, including mammals, reptiles, and birds. In fish, the divisions of the small intestine are not as clear and the terms middle intestine or mid-gut may be used instead of jejunum.The jejunum lies between the duodenum...
or the ileumIleumThe ileum is the final section of the small intestine in most higher vertebrates, including mammals, reptiles, and birds. In fish, the divisions of the small intestine are not as clear and the terms posterior intestine or distal intestine may be used instead of ileum.The ileum follows the duodenum...
. This definition excludes the fistulas arising from the colonColon (anatomy)The colon is the last part of the digestive system in most vertebrates; it extracts water and salt from solid wastes before they are eliminated from the body, and is the site in which flora-aided fermentation of unabsorbed material occurs. Unlike the small intestine, the colon does not play a...
or the appendixVermiform appendixThe appendix is a blind-ended tube connected to the cecum , from which it develops embryologically. The cecum is a pouchlike structure of the colon...
. - Gastric fistula: from the stomachStomachThe stomach is a muscular, hollow, dilated part of the alimentary canal which functions as an important organ of the digestive tract in some animals, including vertebrates, echinoderms, insects , and molluscs. It is involved in the second phase of digestion, following mastication .The stomach is...
to the skin surface
- Enterocutaneous fistula: between the intestine and the skin surface, namely from the duodenum
- (K38.3) Fistula of appendix
- Anal fistulaAnal fistulaAnal fistula, or fistula-in-ano, is an abnormal connection between the epithelialised surface of the anal canal and the perianal skin....
- Anorectal fistula: connecting the rectumRectumThe rectum is the final straight portion of the large intestine in some mammals, and the gut in others, terminating in the anus. The human rectum is about 12 cm long...
or other anorectalAnorectalNot to be confused with anorexia.Anorectal anomalies are medical problems affecting the structure of the anus and rectum. A person with an anorectal problem would have some sort of deformative feature of the anus or rectum, collectively known as an anorectal malformation.Examples of anorectal...
area to the skinSkin-Dermis:The dermis is the layer of skin beneath the epidermis that consists of connective tissue and cushions the body from stress and strain. The dermis is tightly connected to the epidermis by a basement membrane. It also harbors many Mechanoreceptors that provide the sense of touch and heat...
surface. This results in abnormal discharge of fecesFecesFeces, faeces, or fæces is a waste product from an animal's digestive tract expelled through the anus or cloaca during defecation.-Etymology:...
through an opening other than the anusAnusThe anus is an opening at the opposite end of an animal's digestive tract from the mouth. Its function is to control the expulsion of feces, unwanted semi-solid matter produced during digestion, which, depending on the type of animal, may be one or more of: matter which the animal cannot digest,...
. Also called fistula-in-ano.- Fecal fistula: see Anorectal
- Fistula-in-ano
- Anorectal fistula: connecting the rectum
- Anorectal fistula
- (K63.2) Fistula of intestineIntestineIn human anatomy, the intestine is the segment of the alimentary canal extending from the pyloric sphincter of the stomach to the anus and, in humans and other mammals, consists of two segments, the small intestine and the large intestine...
- Enteroenteral fistula: between two parts of the intestineIntestineIn human anatomy, the intestine is the segment of the alimentary canal extending from the pyloric sphincter of the stomach to the anus and, in humans and other mammals, consists of two segments, the small intestine and the large intestine...
- Enteroenteral fistula: between two parts of the intestine
- (K82.3) Fistula of gallbladderGallbladderIn vertebrates the gallbladder is a small organ that aids mainly in fat digestion and concentrates bile produced by the liver. In humans the loss of the gallbladder is usually easily tolerated....
- (K83.3) Fistula of bile ductBile ductA bile duct is any of a number of long tube-like structures that carry bile.Bile, required for the digestion of food, is excreted by the liver into passages that carry bile toward the hepatic duct, which joins with the cystic duct to form the common bile duct, which opens into the intestine.The...
- Biliary fistulaBiliary fistulaA biliary fistula is a type of fistula where bile leaks from the bile ducts into outside areas.-Causes:It can occur as a complication following biliary trauma , either iatrogenic or a result of a penetrating injury.-Presentation:...
: connecting the bileBileBile or gall is a bitter-tasting, dark green to yellowish brown fluid, produced by the liver of most vertebrates, that aids the process of digestion of lipids in the small intestine. In many species, bile is stored in the gallbladder and upon eating is discharged into the duodenum...
ducts to the skin surface, often caused by gallbladderGallbladderIn vertebrates the gallbladder is a small organ that aids mainly in fat digestion and concentrates bile produced by the liver. In humans the loss of the gallbladder is usually easily tolerated....
surgery - Pancreatic fistulaPancreatic fistulaA pancreatic fistula is an abnormal communication between the pancreas and other organs due to leakage of pancreatic secretions from damaged pancreatic ducts. An external pancreatic fistula is one that communicates with the skin, and is also known as a pancreaticocutaneous fistula, whereas an...
: between the pancreasPancreasThe pancreas is a gland organ in the digestive and endocrine system of vertebrates. It is both an endocrine gland producing several important hormones, including insulin, glucagon, and somatostatin, as well as a digestive organ, secreting pancreatic juice containing digestive enzymes that assist...
and the exterior via the abdominal wall
- Biliary fistula
N: Diseases of the urogenital system
Note: in non-medical contexts, the word "fistula" is often used to imply urogenital fistulae.- (N32.1) Vesicointestinal fistulaVesicointestinal fistulaA vesicointestinal fistula is a form of fistula between the bladder and the bowel.-Types:A fistula involving the bladder can have one of many specific names, describing the specific location of its outlet:...
- (N36.0) Urethral fistula
- Innora:between the prostatic utricleProstatic utricleThe prostatic utricle is a small indentation located in the prostatic urethra, at the apex of the urethral crest, on the seminal colliculus , laterally flanked by openings of the ejaculatory ducts...
and the outside of the body
- Innora:between the prostatic utricle
- (N64.0) Fistula of nipple
- (N82) Fistulae involving female genital tract / Obstetric fistulaObstetric fistulaObstetric fistula is a severe medical condition in which a fistula develops between either the rectum and vagina or between the bladder and vagina after severe or failed childbirth, when adequate medical care is not available.-Symptoms and signs:The resulting disorders typically include...
- (N82.0) Vesicovaginal fistulaVesicovaginal fistulaVesicovaginal fistula is a subtype of female urogenital fistula .-Presentation:VVF is an abnormal fistulous tract extending between the bladder and the vagina that allows the continuous involuntary discharge of urine into the vaginal vault....
: between the bladderUrinary bladderThe urinary bladder is the organ that collects urine excreted by the kidneys before disposal by urination. A hollow muscular, and distensible organ, the bladder sits on the pelvic floor...
and the vaginaVaginaThe vagina is a fibromuscular tubular tract leading from the uterus to the exterior of the body in female placental mammals and marsupials, or to the cloaca in female birds, monotremes, and some reptiles. Female insects and other invertebrates also have a vagina, which is the terminal part of the... - (N82.1) Other female urinary-genital tract fistulae
- Cervical fistula: abnormal opening in the cervixCervixThe cervix is the lower, narrow portion of the uterus where it joins with the top end of the vagina. It is cylindrical or conical in shape and protrudes through the upper anterior vaginal wall...
- Cervical fistula: abnormal opening in the cervix
- (N82.2) Fistula of vagina to small intestine
- Enterovaginal fistula: between the intestineIntestineIn human anatomy, the intestine is the segment of the alimentary canal extending from the pyloric sphincter of the stomach to the anus and, in humans and other mammals, consists of two segments, the small intestine and the large intestine...
and the vaginaVaginaThe vagina is a fibromuscular tubular tract leading from the uterus to the exterior of the body in female placental mammals and marsupials, or to the cloaca in female birds, monotremes, and some reptiles. Female insects and other invertebrates also have a vagina, which is the terminal part of the...
- Enterovaginal fistula: between the intestine
- (N82.3) Fistula of vagina to large intestine
- RectovaginalRectovaginal fistulaA rectovaginal fistula is a medical condition where there is a fistula or abnormal connection between the rectum and the vagina. Rectovaginal fistula may be extremely debilitating. If the opening between the rectum and vagina is wide it will allow both flatulence and feces to escape through the...
: between the rectumRectumThe rectum is the final straight portion of the large intestine in some mammals, and the gut in others, terminating in the anus. The human rectum is about 12 cm long...
and the vaginaVaginaThe vagina is a fibromuscular tubular tract leading from the uterus to the exterior of the body in female placental mammals and marsupials, or to the cloaca in female birds, monotremes, and some reptiles. Female insects and other invertebrates also have a vagina, which is the terminal part of the...
- Rectovaginal
- (N82.4) Other female intestinal-genital tract fistulae
- (N82.5) Female genital tract-skin fistulae
- (N82.8) Other female genital tract fistulae
- (N82.9) Female genital tract fistula, unspecified
- (N82.0) Vesicovaginal fistula
Q: Congenital malformations, deformations and chromosomal abnormalities
- (Q18.0) SinusSinus (anatomy)Sinus is Latin for "bay", "pocket", "curve", or "bosom". In anatomy, the term is used in various contexts.A sinus is a sack or cavity in any organ or tissue, or an abnormal cavity or passage caused by the destruction of tissue...
, fistula and cystCystA cyst is a closed sac, having a distinct membrane and division on the nearby tissue. It may contain air, fluids, or semi-solid material. A collection of pus is called an abscess, not a cyst. Once formed, a cyst could go away on its own or may have to be removed through surgery.- Locations :* Acne...
of branchial cleft- Congenital Preauricular fistula: A small pit in front of the earEarThe ear is the organ that detects sound. It not only receives sound, but also aids in balance and body position. The ear is part of the auditory system....
. Also called Fistula Auris Congenita or Ear Pit.
- Congenital Preauricular fistula: A small pit in front of the ear
- (Q26.6) Portal vein-hepatic arteryHepatic arteryHepatic artery can refer to:* Common hepatic artery * Hepatic artery proper...
fistula - (Q38.0) Congenital fistula of lipLipLips are a visible body part at the mouth of humans and many animals. Lips are soft, movable, and serve as the opening for food intake and in the articulation of sound and speech...
- (Q38.4) Congenital fistula of salivary glandSalivary glandThe salivary glands in mammals are exocrine glands, glands with ducts, that produce saliva. They also secrete amylase, an enzyme that breaks down starch into maltose...
- (Q42.0) Congenital absence, atresiaAtresiaAtresia is a condition in which a body orifice or passage in the body is abnormally closed or absent.Examples of atresia include:* Imperforate anus - malformation of the opening between the rectum and anus....
and stenosisStenosisA stenosis is an abnormal narrowing in a blood vessel or other tubular organ or structure.It is also sometimes called a stricture ....
of rectumRectumThe rectum is the final straight portion of the large intestine in some mammals, and the gut in others, terminating in the anus. The human rectum is about 12 cm long...
with fistula - (Q42.2) Congenital absence, atresiaAtresiaAtresia is a condition in which a body orifice or passage in the body is abnormally closed or absent.Examples of atresia include:* Imperforate anus - malformation of the opening between the rectum and anus....
and stenosisStenosisA stenosis is an abnormal narrowing in a blood vessel or other tubular organ or structure.It is also sometimes called a stricture ....
of anusAnusThe anus is an opening at the opposite end of an animal's digestive tract from the mouth. Its function is to control the expulsion of feces, unwanted semi-solid matter produced during digestion, which, depending on the type of animal, may be one or more of: matter which the animal cannot digest,...
with fistula - (Q43.6) Congenital fistula of rectumRectumThe rectum is the final straight portion of the large intestine in some mammals, and the gut in others, terminating in the anus. The human rectum is about 12 cm long...
and anusAnusThe anus is an opening at the opposite end of an animal's digestive tract from the mouth. Its function is to control the expulsion of feces, unwanted semi-solid matter produced during digestion, which, depending on the type of animal, may be one or more of: matter which the animal cannot digest,... - (Q51.7) Congenital fistulae between uterusUterusThe uterus or womb is a major female hormone-responsive reproductive sex organ of most mammals including humans. One end, the cervix, opens into the vagina, while the other is connected to one or both fallopian tubes, depending on the species...
and digestiveDigestiveDigestive may refer to:*Digestion, biological process of metabolism*Digestive biscuit, a British semi-sweet biscuit*Digestif, small beverage at the end of a meal...
and urinary tracts - (Q52.2) Congenital rectovaginal fistulaRectovaginal fistulaA rectovaginal fistula is a medical condition where there is a fistula or abnormal connection between the rectum and the vagina. Rectovaginal fistula may be extremely debilitating. If the opening between the rectum and vagina is wide it will allow both flatulence and feces to escape through the...
T: External causes
- (T14.5) Traumatic arteriovenous fistula
- (T81.8) Persistent postoperative fistula
Types
Various types of fistulas include:| Name | Definition |
|---|---|
| Blind | with only one open end |
| Complete | with both external and internal openings |
| Incomplete | a fistula with an external skin opening, which does not connect to any internal organ |
Although most fistulas are in forms of a tube, some can also have multiple branches.
Causes
Various causes of fistula are:| Category | Elaboration |
|---|---|
| Diseases | Inflammatory bowel diseases, such as Crohn's disease Crohn's disease Crohn's disease, also known as regional enteritis, is a type of inflammatory bowel disease that may affect any part of the gastrointestinal tract from mouth to anus, causing a wide variety of symptoms... and ulcerative colitis Ulcerative colitis Ulcerative colitis is a form of inflammatory bowel disease . Ulcerative colitis is a form of colitis, a disease of the colon , that includes characteristic ulcers, or open sores. The main symptom of active disease is usually constant diarrhea mixed with blood, of gradual onset... , are the leading causes of anorectal, enteroenteral, and enterocutaneous fistulas. A person with severe stage-3 hidradenitis suppurativa Hidradenitis suppurativa Hidradenitis suppurativa is a skin disease that most commonly affects areas bearing apocrine sweat glands or sebaceous glands, such as the underarms, breasts, inner thighs, groin and buttocks.-Overview:... will also develop fistulas. |
| Medical treatment | Complications from gallbladder surgery can lead to biliary fistula. Radiation therapy can lead to vesicovaginal fistula. An arteriovenous fistula can be deliberately created, as described below in therapeutic use. |
| Trauma | Head trauma can lead to perilymph fistula Perilymph fistula A labyrinthine fistula is an abnormal opening in the bony capsule of the inner ear, resulting in leakage of the perilymph from the semicircular canals into the middle ear . This includes specifically a perilymph fistula , an abnormal connection between the fluid of the inner ear and the air-filled... s, whereas trauma to other parts of the body can cause arteriovenous fistulas. Obstructed labor can lead to vesicovaginal and rectovaginal fistulas. An obstetric fistula Obstetric fistula Obstetric fistula is a severe medical condition in which a fistula develops between either the rectum and vagina or between the bladder and vagina after severe or failed childbirth, when adequate medical care is not available.-Symptoms and signs:The resulting disorders typically include... develops when blood supply to the tissues of the vagina and the bladder (and/or rectum) is cut off during prolonged obstructed labor. The tissues die and a hole forms through which urine and/or feces pass uncontrollably. Vesicovaginal Vesicovaginal fistula Vesicovaginal fistula is a subtype of female urogenital fistula .-Presentation:VVF is an abnormal fistulous tract extending between the bladder and the vagina that allows the continuous involuntary discharge of urine into the vaginal vault.... and rectovaginal fistula Rectovaginal fistula A rectovaginal fistula is a medical condition where there is a fistula or abnormal connection between the rectum and the vagina. Rectovaginal fistula may be extremely debilitating. If the opening between the rectum and vagina is wide it will allow both flatulence and feces to escape through the... s may also be caused by rape, in particular gang rape, and rape with foreign objects, as evidenced by the abnormally high number of women in conflict areas who have suffered fistulae. In 2003, thousands of women in eastern Congo presented themselves for treatment of traumatic fistula caused by systematic, violent gang rape that occurred during the country's five years of war. So many cases have been reported that the destruction of the vagina is considered a war injury and recorded by doctors as a crime of combat. |
Treatment
Treatment for fistulae varies depending on the cause and extent of the fistula, but often involves surgical intervention combined with antibioticAntibiotic
An antibacterial is a compound or substance that kills or slows down the growth of bacteria.The term is often used synonymously with the term antibiotic; today, however, with increased knowledge of the causative agents of various infectious diseases, antibiotic has come to denote a broader range of...
therapy.
Typically the first step in treating a fistula is an examination by a doctor to determine the extent and "path" that the fistula takes through the tissue.
In some cases the fistula is temporarily covered, for example a fistula caused by cleft palate is often treated with a palatal obturator
Palatal obturator
A palatal obturator is a prosthesis that totally occludes an opening such as an orinasal fistula . They are similar to dental retainers, but without the front wire. Palatal obturators are typically short-term prosthetics used to close defects of the hard/soft palate that may affect speech...
to delay the need for surgery to a more appropriate age.
Surgery is often required to assure adequate drainage of the fistula (so that pus
Pus
Pus is a viscous exudate, typically whitish-yellow, yellow, or yellow-brown, formed at the site of inflammatory during infection. An accumulation of pus in an enclosed tissue space is known as an abscess, whereas a visible collection of pus within or beneath the epidermis is known as a pustule or...
may escape without forming an abscess
Abscess
An abscess is a collection of pus that has accumulated in a cavity formed by the tissue in which the pus resides due to an infectious process or other foreign materials...
). Various surgical procedures are commonly used, most commonly fistulotomy
Fistulotomy
A Fistulotomy is the surgical opening of a fistulous tract. They can be performed by excision of the tract and surrounding tissue, simple division of the tract, or gradual division and assisted drainage of the tract by means of a seton; a cord passed through the tract in a loop which is slowly...
, placement of a seton (a cord that is passed through the path of the fistula to keep it open for draining), or an endorectal flap procedure (where healthy tissue is pulled over the internal side of the fistula to keep feces or other material from reinfecting the channel). Treatment involves filling the fistula with fibrin glue; also plugging it with plugs made of porcine small intestine submucosa have also been explored in recent years, with variable success. Surgery for anorectal fistulae is not without side effects, including recurrence, reinfection, and incontinence.
It is important to note that surgical treatment of a fistula without diagnosis or management of the underlying condition, if any, is not recommended. For example, surgical treatment of fistulae in Crohn's disease
Crohn's disease
Crohn's disease, also known as regional enteritis, is a type of inflammatory bowel disease that may affect any part of the gastrointestinal tract from mouth to anus, causing a wide variety of symptoms...
can be effective, but if the Crohn's disease itself is not treated, the rate of recurrence of fistula is very high (well above 50%).
Therapeutic use
In end stage renal failure patients, a cimino fistulaCimino fistula
A Cimino fistula, also Cimino-Brescia fistula, surgically created arteriovenous fistula and arteriovenous fistula , is a type of vascular access for hemodialysis...
is often deliberately created in the arm by means of a short day surgery in order to permit easier withdrawal of blood for hemodialysis
Hemodialysis
In medicine, hemodialysis is a method for removing waste products such as creatinine and urea, as well as free water from the blood when the kidneys are in renal failure. Hemodialysis is one of three renal replacement therapies .Hemodialysis can be an outpatient or inpatient therapy...
.
As a radical treatment for portal hypertension
Portal hypertension
In medicine, portal hypertension is hypertension in the portal vein and its tributaries.It is often defined as a portal pressure gradient of 10 mmHg or greater.-Causes:Causes can be divided into prehepatic, intrahepatic, and posthepatic...
, surgical creation of a portacaval fistula produces an anastomosis between the hepatic portal vein
Hepatic portal vein
The hepatic portal vein is not a true vein, because it does not conduct blood directly to the heart. It is a vessel in the abdominal cavity that drains blood from the gastrointestinal tract and spleen to capillary beds in the liver...
and the inferior vena cava
Inferior vena cava
The inferior vena cava , also known as the posterior vena cava, is the large vein that carries de-oxygenated blood from the lower half of the body into the right atrium of the heart....
across the omental foramen (of Winslow). This spares the portal venous system from high pressure which can cause esophageal varices, caput medusae, and hemorrhoids.