A fistula (from Middle High German vistula “an ulcer deep in tubes or hollow passages”, from Latin fistula , “pipe”, “tube”) is a non-naturally pre-existing, tubular or network-like connection between an internal hollow organ and other organs or the body surface .
In terms of the fine tissue structure, a distinction is also made between two types, which differ significantly in their ability to heal spontaneously after the cause has been eliminated: the tubular fistula and the lip fistula . The former is only lined with granulation tissue and heals after focal treatment (removal of the festering cause, for example by a sequestrectomy).
The latter, however, has an epithelial lining (comparable to a natural body opening) and therefore no healing can take place without complete excision (so-called fistulectomy).
Fistulas can arise from a chronic (e.g. Crohn's disease ) or acute inflammation ( abscess ) or from external mechanical influences (accident, surgery, childbirth). An abscess is a cavity inside the body in which the pus that forms when it becomes infected accumulates. If the inflammation persists, the abscess can burst or the body creates a way to evacuate the pus from the tissue: the fistula.
Examples of types of fistula
Incomplete list of fistula types or locations:
- arteriovenous fistula : course between an artery and a vein
- enterocutaneous fistula : course between intestine and skin
- enterovesical fistula: course between the intestine and urinary bladder (this can also lead to pneumaturia )
- enterogenital or enterovaginal fistula: course between the intestine and the genital organs
- perianal fistula: exit of the fistula in the area of the anus (most common cause: proctodeal gland infection)
- interenteric fistula: course between sections of the small or large intestine
- Biliary fistula: internal or external bile-carrying fistula emanating from the gallbladder or the extra- or intrahepatic bile ducts. Classification: as an outer G. with mouth on the body surface (Fistula biliocutanea) or in internal organs, e.g. B. the bronchi (Fistula bronchobiliaris) or as internal G. (Fistula biliodigestiva), in which a connection between the bile duct system or gall bladder u. Stomach or intestines. Etiol .: spontaneous external G. postoperatively, as a result of suture insufficiency or after removal of a bile duct drainage; a surgically applied external relief fistula, e.g. B. as a drainage fistula (gallbladder drainage). Spontaneous internal G. after perforation of the biliary tract (e.g. gallbladder perforation) through stones, after perforation of a duodenal ulcer or post-traumatic; In addition, artificial (surgically applied) internal relief fistula for drainage of bile in the stomach or small intestine (= biliogastric or biliointestinal anastomosis). Compl .: with internal G. v. a. Shrink gall bladder with chronic recurrent cholangitis, with external G. z. B. Osteoporosis, disturbed fat absorption, loss of electrolytes.
- Pilonidal sinus or coccyx fistula: opening of the fistula in the gluteal fold
- submucosal fistula (fistula under a mucous membrane)
- Vesicovaginal fistula (VVF), bladder-vaginal fistula or obstetric fistula: between the birth canal and the urinary bladder .
- Urethrovaginal fistula : fistula between the urethra and the vagina
- Esophagotracheal fistula : fistula between the esophagus and trachea
- Rectovaginal Fistula (RVF): between the vagina and rectum.
- aortoduodenal fistula: rare complication of an aortic aneurysm , the fistula runs from the aneurysm to the duodenum , causing severe gastrointestinal bleeding with a poor prognosis.
- perineal fistula: fistula in the area of the perineum
- aortocaval fistula: a rare complication of an aortic aneurysm, the fistula runs from the aneurysm to the inferior vena cava or to the left or right iliac vein, this (a type of arteriovenous aneurysm) causes venous congestion in the legs and right heart failure .
- Semicircular canal dehiscence , a perilymph fistula of the anterior semicircular canal that can lead to autophonia , dizziness , Tullio phenomenon, and hearing loss .
- Lymphatic fistula
- Tooth fistula: the connection between the inflamed tooth root and the oral cavity
- Rumen fistula : the connection between the rumen and the outside world is used for scientific research or for the extraction of rumen juice
Examples of possible forms of therapy
- Antibiotics. The body protects itself from the source of infection by encapsulating it. The bacteria cannot spread through the resulting membrane in the body. On the other hand, antibiotics do not reach the focus of infection in a therapeutically sufficient concentration, so that surgical intervention is usually unavoidable.
- Thread drainage . The drainage with a thread (English Seton) for a period of usually about three to six weeks turns the acute inflammation into a chronic form.
- Surgical intervention splits the fistula
- Circumcision and removal of the cause. Only if the cause has not been found or has not been eliminated does surgical resection show a high rate of recurrence .
- drug treatment, e.g. B. by infliximab in Crohn's disease
Anal fistulas that have developed into more complex fistulas and have grown together up to the opposite side of the anus can often only be removed inadequately and, after many years, can also be the starting point for the development of anal cancer .
- Jürgen Martin: The 'Ulmer Wundarznei'. Introduction - Text - Glossary on a monument to German specialist prose from the 15th century. Königshausen & Neumann, Würzburg 1991 (= Würzburg medical-historical research. Volume 52), ISBN 3-88479-801-4 (also medical dissertation Würzburg 1990), p. 186.
- The systematics of the primary perianal and pelvirectal abscesses and fistulas from books.google.de, accessed on May 6, 2016.
- Fistulas: Often unpleasant companions for many ailments from Wissen-gesundheit.de, accessed on May 6, 2016.
- Herbert Reindell , Helmut Klepzig: Diseases of the heart and the vessels. In: Ludwig Heilmeyer (ed.): Textbook of internal medicine. Springer-Verlag, Berlin / Göttingen / Heidelberg 1955; 2nd edition, ibid. 1961, pp. 450-598, here: p. 596.
- Tooth fistula at paradisi.de, accessed on May 6, 2016.
- Surgery portal abscess, opening abscesses, pus, furuncle at chirurgie-portal.de, accessed on May 6, 2016.
- Incision and drainage in the abscess endoskopie-online.at, accessed on May 6, 2016.
- Fistulectomy and Mucosal Flap Plastic Endoskopie-online.at , accessed on May 6, 2016.