A fistula (plural: fistulas or fistulae ; from

Latin Latin (, or , ) is a classical language belonging to the Italic branch of the Indo-European languages. Latin was originally a dialect spoken in the lower Tiber area (then known as Latium) around present-day Rome, but through the power ...

''fistula'', "tube, pipe") in

anatomy Anatomy () is the branch of biology concerned with the study of the structure of organisms and their parts. Anatomy is a branch of natural science that deals with the structural organization of living things. It is an old science, having its ...

is an abnormal connection between two hollow spaces (technically, two epithelialized surfaces), such as

blood vessel Blood vessels are the structures of the circulatory system that transport blood throughout the human body. These vessels transport blood cells, nutrients, and oxygen to the tissues of the body. They also take waste and carbon dioxide away from ...

intestine The gastrointestinal tract (GI tract, digestive tract, alimentary canal) is the tract or passageway of the digestive system that leads from the mouth to the anus. The GI tract contains all the major organs of the digestive system, in humans a ...

s, or other hollow organs. Types of fistula can be described by their location. Anal fistulas connect between the anal canal and the

perianal The anus ( Latin, 'ring' or 'circle') 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, the residual semi-solid waste that remains after food digestion, which, ...

skin. Anovaginal or rectovaginal fistulas occur when a hole develops between the anus or rectum and the

vagina In mammals, the vagina is the elastic, muscular part of the female genital tract. In humans, it extends from the vestibule to the cervix. The outer vaginal opening is normally partly covered by a thin layer of mucosal tissue called the hy ...

. Colovaginal fistulas occur between the colon and the vagina. Urinary tract fistulas are abnormal openings within the urinary tract or an abnormal connection between the urinary tract and another organ such as between the bladder and the

uterus The uterus (from Latin ''uterus'', plural ''uteri'') or womb () is the organ in the reproductive system of most female mammals, including humans that accommodates the embryonic and fetal development of one or more embryos until birth. The ...

in a vesicouterine fistula, between the bladder and the vagina in a vesicovaginal fistula, and between the urethra and the vagina in urethrovaginal fistula. When occurring between two parts of the intestine, it is known as an enteroenteral fistula, between the small intestine and the skin as an enterocutaneous fistula, and between the colon and the skin as a colocutaneous fistula. Fistulas can result from an infection or inflammation, injury or surgery. Fistulas are sometimes surgically created as part of a treatment, for example arteriovenous fistulas for

hemodialysis Hemodialysis, also spelled haemodialysis, or simply dialysis, is a process of purifying the blood of a person whose kidneys are not working normally. This type of dialysis achieves the extracorporeal removal of waste products such as creatinin ...

. Treatment for fistula varies depending on the cause and extent of the fistula, but often involves surgical intervention combined with

antibiotic An antibiotic is a type of antimicrobial substance active against bacteria. It is the most important type of antibacterial agent for fighting pathogenic bacteria, bacterial infections, and antibiotic medications are widely used in the therapy, ...

therapy. In some cases the fistula is temporarily covered using a fibrin glue or plug. Catheters may be required to drain a fistula. Globally, every year between 50,000 and 100,000 women are affected by fistula relating to childbirth. In

botany Botany, also called plant science (or plant sciences), plant biology or phytology, is the science of plant life and a branch of biology. A botanist, plant scientist or phytologist is a scientist who specialises in this field. The term "bot ...

, the term is most common in its adjectival forms, where it is used in binomial names to refer to species that are distinguished by hollow or tubular structures. '' Monarda fistulosa'', for example, has tubular flowers.Identification of Monarda fistulosa
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, 2014. The term was first used in the 14th century.

Definition

A fistula is an abnormal connection between vessels or organs that do not usually connect. It can be due to a disease or trauma, or purposely surgically created.

Classification

Various types of fistulas include: * Blind: Only one open end; may also be called sinus tracts. * Complete: Both internal and external openings. * Incomplete: An external skin opening that does not connect to any internal organ. Although most fistulas are in forms of a tube, some can also have multiple branches.

Location

Types of fistula can be described by their location. Anal fistulas connect between the epithelialized surface of the anal canal and the perianal skin. Anovaginal or rectovaginal fistulas occur when a hole develops between the anus or rectum and the vagina. Colovaginal fistulas occur between the colon and the vagina. Urinary tract fistulas are abnormal openings within the urinary tract or an abnormal connection between the urinary tract and another organ such as between the bladder and the uterus in a vesicouterine fistula, between the bladder and the vagina in a vesicovaginal fistula, and between the urethra and the vagina in urethrovaginal fistula. When occurring between two parts of the intestine, it is known as an enteroenteral fistula, between the small intestine and the skin as an enterocutaneous fistula, and between the small intestine and the colon as a colocutaneous fistula. The following list is sorted by the International Statistical Classification of Diseases and Related Health Problems.

H: Diseases of the eye, adnexa, ear, and mastoid process

* (H04.6) Lacrimal fistula * (H05.81) Carotid cavernous fistula * (H70.1)

Mastoid fistula The mastoid part of the temporal bone is the posterior (back) part of the temporal bone, one of the bones of the skull. Its rough surface gives attachment to various muscles (via tendons) and it has Foramen, openings for blood vessels. From its bo ...

** Craniosinus fistula: between the intracranial space and a paranasal sinus * (H83.1)

Labyrinthine fistula A labyrinthine fistula is an abnormal opening in the inner ear. This can result in leakage of the perilymph into the middle ear. This includes specifically a perilymph fistula (PLF), an abnormal connection between the fluid of the inner ear and the ...

Perilymph fistula A labyrinthine fistula is an abnormal opening in the inner ear. This can result in leakage of the perilymph into the middle ear. This includes specifically a perilymph fistula (PLF), an abnormal connection between the fluid of the inner ear and the ...

: tear between the membranes between the middle and inner ears *

Preauricular fistula Preauricular sinuses and preauricular cysts are two common congenital malformations. Each involves the external ear. The difference between them is that a cyst does not connect with the skin, but a sinus does. Frequency of preauricular sinus dif ...

: usually on the top of the

cristae helicis A crista (; plural cristae) is a fold in the inner membrane of a mitochondrion. The name is from the Latin for ''crest'' or ''plume'', and it gives the inner membrane its characteristic wrinkled shape, providing a large amount of surface area fo ...

of the ears

I: Diseases of the circulatory system

* (I25.4)

Coronary arteriovenous fistula Coronary () may, as shorthand in English, be used to mean: * Coronary circulation, the system of arteries and veins in mammals ** Coronary artery disease **Coronary occlusion ** A myocardial infarction, a heart attack As adjective * Referring to ...

, acquired * (I28.0) Arteriovenous fistula of

pulmonary vessels The pulmonary circulation is a division of the circulatory system in all vertebrates. The circuit begins with deoxygenated blood returned from the body to the right atrium of the heart where it is pumped out from the right ventricle to the lungs. ...

** Pulmonary arteriovenous fistula: between an artery and vein of the lungs, resulting in shunting of blood. This results in improperly oxygenated blood. * (I67.1) Cerebral arteriovenous fistula, acquired * (I77.0) Arteriovenous fistula, acquired * (I77.2) Fistula of

artery An artery (plural arteries) () is a blood vessel in humans and most animals that takes blood away from the heart to one or more parts of the body (tissues, lungs, brain etc.). Most arteries carry oxygenated blood; the two exceptions are the pu ...

J: Diseases of the respiratory system

* (J86.0) Pyothorax with fistula * (J95.0) Tracheoesophageal fistula, between the trachea and the esophagus. This may be congenital or acquired, for example as a complication of a tracheostomy.

K: Diseases of the digestive system

* (K11.4) Salivary gland fistula * (K31.6) Fistula of stomach and duodenum * (K31.6) Gastrocolic fistula * (K31.6)

Gastrojejunocolic fistula A gastrojejunocolic fistula is a disorder of the human gastrointestinal tract. It may form between the transverse colon and the upper jejunum after a Billroth II surgical procedure. (The Billroth procedure attaches the jejunum to the remainder of t ...

– after a Billroth II 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 halitosis. **

Enterocutaneous fistula An enterocutaneous fistula (ECF) is an abnormal communication between the small or large bowel and the skin that allows the contents of the stomach or intestines to leak through an opening in the skin. Causes The mnemonic HIS FRIENDS can be used ...

: between the intestine and the skin surface, namely from the duodenum or the jejunum or the ileum. This definition excludes the fistulas arising from the colon or the

appendix Appendix, or its plural form appendices, may refer to: __NOTOC__ In documents * Addendum, an addition made to a document by its author after its initial printing or publication * Bibliography, a systematic list of books and other works * Index (pub ...

. **

Gastric fistula The stomach is a muscular, hollow organ in the gastrointestinal tract of humans and many other animals, including several invertebrates. The stomach has a dilated structure and functions as a vital organ in the digestive system. The stomach is ...

: from the stomach to the skin surface * (K38.3) Fistula of appendix * () Anal and rectal fissures and fistulas ** () Anal fistula ** ()

Anorectal fistula Anal fistula is a chronic abnormal communication between the epithelialised surface of the anal canal and usually the perianal skin. An anal fistula can be described as a narrow tunnel with its internal opening in the anal canal and its externa ...

(fecal fistula, fistula-in-ano): connecting the rectum or other anorectal area to the

skin Skin is the layer of usually soft, flexible outer tissue covering the body of a vertebrate animal, with three main functions: protection, regulation, and sensation. Other cuticle, animal coverings, such as the arthropod exoskeleton, have diffe ...

surface. This results in abnormal discharge of

feces Feces ( or faeces), known colloquially and in slang as poo and poop, are the solid or semi-solid remains of food that was not digested in the small intestine, and has been broken down by bacteria in the large intestine. Feces contain a rela ...

through an opening other than the anus. * (K63.2) Fistula of intestine ** Enteroenteral fistula: between two parts of the intestine * (K82.3) Fistula of gallbladder * (K83.3) Fistula of bile duct ** Biliary fistula: connecting the bile ducts to the skin surface, often caused by gallbladder surgery ** Pancreatic fistula: between the

pancreas The pancreas is an organ of the digestive system and endocrine system of vertebrates. In humans, it is located in the abdomen behind the stomach and functions as a gland. The pancreas is a mixed or heterocrine gland, i.e. it has both an en ...

and the exterior via the abdominal wall

M: Diseases of the musculoskeletal system and connective tissue

* (M25.1) Fistula of joint

N: Diseases of the urogenital system

* (N32.1)

Vesicointestinal fistula A vesicointestinal fistula (or intestinovesical 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: * Bladder ...

* (N36.0) Urethral fistula ** Innora:between the prostatic utricle and the outside of the body * (N64.0) Fistula of nipple * (N82) Fistulae involving female genital tract / Obstetric fistula ** (N82.0) Vesicovaginal fistula: between the bladder and the

** (N82.1) Other

female urinary-genital tract fistulae Female (symbol: ♀) is the sex of an organism that produces the large non-motile ova (egg cells), the type of gamete (sex cell) that fuses with the male gamete during sexual reproduction. A female has larger gametes than a male. Females a ...

***

Cervical fistula In anatomy, cervical is an adjective that has two meanings: # of or pertaining to any neck. # of or pertaining to the female cervix: i.e., the ''neck'' of the uterus. *Commonly used medical phrases involving the neck are ** cervical collar **cervi ...

: abnormal opening in the cervix ** (N82.2) Fistula of vagina to small intestine *** Enterovaginal fistula: between the

and the vagina ** (N82.3)

Fistula of vagina to large intestine A rectovaginal fistula is a medical condition where there is a fistula or abnormal connection between the rectum and the vagina. Rectovaginal fistulae may be extremely debilitating. If the opening between the rectum and vagina is wide it will al ...

*** Rectovaginal: between the rectum and the vagina ** (N82.4) Other female intestinal-genital tract fistulae ** (N82.5) Female genital tract-skin fistulae ** (N82.8) Other

female genital tract fistulae Female (symbol: ♀) is the sex of an organism that produces the large non-motile ova (egg cells), the type of gamete (sex cell) that fuses with the male gamete during sexual reproduction. A female has larger gametes than a male. Females an ...

** (N82.9)

Female genital tract fistula Female (symbol: ♀) is the sex of an organism that produces the large non-motile ova (egg cells), the type of gamete (sex cell) that fuses with the male gamete during sexual reproduction. A female has larger gametes than a male. Females a ...

, unspecified

Q: Congenital malformations, deformations and chromosomal abnormalities

* (Q18.0) Sinus, fistula and cyst of branchial cleft ** Congenital preauricular fistula: A small pit in front of the ear. Also known as an ear pit or

preauricular sinus Preauricular sinuses and preauricular cysts are two common congenital malformations. Each involves the external ear. The difference between them is that a cyst does not connect with the skin, but a sinus does. Frequency of preauricular sinus dif ...

. * (Q26.6) Portal vein- hepatic artery fistula * (Q38.0) Congenital fistula of lip * (Q38.4) Congenital fistula of salivary gland * (Q42.0) Congenital absence,

atresia Atresia is a condition in which an orifice or passage in the body is (usually abnormally) closed or absent. Examples of atresia include: *Aural atresia, a congenital deformity where the ear canal is underdeveloped. * Biliary atresia, a condition ...

and stenosis of rectum with fistula * (Q42.2) Congenital absence,

and stenosis of anus with fistula * (Q43.6) Congenital fistula of rectum and anus * (Q51.7) Congenital fistulae between

and digestive and urinary tracts * (Q52.2) Congenital rectovaginal fistula

T: External causes

* (T14.5)

Traumatic arteriovenous fistula Trauma most often refers to: *Major trauma, in physical medicine, severe physical injury caused by an external source *Psychological trauma, a type of damage to the psyche that occurs as a result of a severely distressing event *Traumatic inju ...

* (T81.8)

Persistent postoperative fistula Persistent may refer to: * Persistent data * Persistent data structure * Persistent identifier * Persistent memory * Persistent organic pollutant * Persistent Systems Persistent Systems is an Indian multinational technology services comp ...

Causes

* Disease: Infections including an anorectal abscess and inflammatory diseases including Crohn's disease and ulcerative colitis can result in fistulas. Fistulas to the anus may occur in hidradenitis suppurativa. In women, fistulas can also occur following pelvic infection and inflammation. Probed gastrocutaneous fistula tract

* Surgical and medical treatment: Complications from gallbladder surgery can lead to biliary fistulas. As well as being congenital or resulting from trauma, arteriovenous fistulas are created purposefully for

. Radiation therapy to the pelvis can lead to vesicovaginal fistulas. Persistent gastrocutenaous fistulas can develop after gastrostomy. * Trauma: Prolonged childbirth can lead to fistulas in women, in whom abnormal connections may occur between the bladder and vagina, or the rectum and vagina. An obstetric fistula 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 and rectovaginal fistulas 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 developed fistulae. In 2003, thousands of women in eastern

Congo Congo or The Congo may refer to either of two countries that border the Congo River in central Africa: * Democratic Republic of the Congo, the larger country to the southeast, capital Kinshasa, formerly known as Zaire, sometimes referred to a ...

presented themselves for treatment of traumatic fistulas caused by systematic, violent gang rape, often also with sharp objects 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.Emily Wax, Washington Post Foreign Service. Saturday, October 25, 2003; Page A01 "A Brutal Legacy of Congo War"
/ref> Head trauma can lead to

perilymph fistula A labyrinthine fistula is an abnormal opening in the inner ear. This can result in leakage of the perilymph into the middle ear. This includes specifically a perilymph fistula (PLF), an abnormal connection between the fluid of the inner ear and the ...

s, whereas trauma to other parts of the body can cause arteriovenous fistulas.

Treatment

Treatment for fistula varies depending on the cause and extent of the fistula, but often involves surgical intervention combined with

therapy. In some cases the fistula is temporarily covered, using a fibrin glue or plug. Catheters may be required to drain a fistula. Surgery is often required to assure adequate drainage of the fistula (so that pus may escape without forming an abscess). Various surgical procedures are 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). Management involves treating any underlying causative condition. 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 the fistula is very high (well above 50%).

Therapeutic use

In people with kidney failure, requiring dialysis, a cimino fistula is often deliberately created in the arm by means of a short day surgery in order to permit easier withdrawal of blood for

. 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.

Epidemiology

Globally, every year between 50,000 and 100,000 women are affected by fistula relating to childbirth.

Botany

, the term is most common in its adjectival forms, where it is used in binomial names to refer to species that are distinguished by hollow or tubular structures. '' Monarda fistulosa'', for example, has tubular flowers; '' Eutrochium fistulosum'' has a tubular stem; '' Allium fistulosum'' has hollow or tubular leaves, and ''

Acacia seyal ''Vachellia seyal'', the red acacia, known also as the shittah tree (the source of shittim wood), is a thorny, 6– to 10-m-high (20 to 30 ft) tree with a pale greenish or reddish bark. At the base of the feathery leaves, two straight, light ...

'' subsp. ''fistula'' is the subspecies with hollow spines.

Society and culture

The term was first used in the 14th century.

References

External links

{{Authority control Animal anatomy Anatomical pathology Anatomical terminology Symptoms and signs