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 of the ...

''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 The blood vessels are the components 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 ...

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 ...

s, or other hollow

organs In biology, an organ is a collection of tissues joined in a structural unit to serve a common function. In the hierarchy of life, an organ lies between tissue and an organ system. Tissues are formed from same type cells to act together in a f ...

. Types of fistula can be described by their location.

Anal 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 ...

s connect between the

anal canal The anal canal is the part that connects the rectum to the anus, located below the level of the pelvic diaphragm. It is located within the anal triangle of the perineum, between the right and left ischioanal fossa. As the final functional segment ...

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, d ...

skin. Anovaginal or

rectovaginal fistula 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 allo ...

s occur when a hole develops between the anus or

rectum The rectum is the final straight portion of the large intestine in humans and some other mammals, and the Gastrointestinal tract, gut in others. The adult human rectum is about long, and begins at the rectosigmoid junction (the end of the s ...

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 hymen ...

. Colovaginal fistulas occur between the colon and the vagina. Urinary tract fistulas are abnormal openings within the

urinary tract The urinary system, also known as the urinary tract or renal system, consists of the kidneys, ureters, bladder, and the urethra. The purpose of the urinary system is to eliminate waste from the body, regulate blood volume and blood pressure, con ...

or an abnormal connection between the urinary tract and another organ such as between the

bladder The urinary bladder, or simply bladder, is a hollow organ in humans and other vertebrates that stores urine from the kidneys before disposal by urination. In humans the bladder is a distensible organ that sits on the pelvic floor. Urine enters ...

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 uter ...

in a

vesicouterine fistula Vesicouterine fistula refers to an abnormal communication between the bladder and uterus. The first case of vesicouterine fistula was reported in 1908. It was however first described in 1957 by Abdel Fattah Youssef, an obstetrician and gynaecolo ...

, between the bladder and the vagina in a vesicovaginal fistula, and between the

urethra The urethra (from Greek οὐρήθρα – ''ourḗthrā'') is a tube that connects the urinary bladder to the urinary meatus for the removal of urine from the body of both females and males. In human females and other primates, the urethra con ...

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 The small intestine or small bowel is an organ in the gastrointestinal tract where most of the absorption of nutrients from food takes place. It lies between the stomach and large intestine, and receives bile and pancreatic juice through the p ...

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 fistula An 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 ...

s 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 bacterial infections, and antibiotic medications are widely used in the treatment and prevention of ...

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 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 "botany" comes from the Ancient Greek w ...

, the term is most common in its adjectival forms, where it is used in

binomial names In taxonomy, binomial nomenclature ("two-term naming system"), also called nomenclature ("two-name naming system") or binary nomenclature, is a formal system of naming species of living things by giving each a name composed of two parts, bot ...

to refer to species that are distinguished by hollow or tubular structures. ''

Monarda fistulosa ''Monarda fistulosa'', the wild bergamot or bee balm,Wild Bergamot
, Edmonton Naturalization Group< ...

'', for example, has tubular flowers.Identification of Monarda fistulosa
subpage o
Discover Life
, 2014. The term was first used in the 14th century.

Definition

A fistula is an abnormal connection between

vessels Vessel(s) or The Vessel may refer to: Biology *Blood vessel, a part of the circulatory system and function to transport blood throughout the body *Lymphatic vessel, a thin walled, valved structure that carries lymph *Vessel element, a narrow wat ...

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 The International Classification of Diseases (ICD) is a globally used diagnostic tool for epidemiology, health management and clinical purposes. The ICD is maintained by the World Health Organization (WHO), which is the directing and coordinating ...

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

* (H04.6)

Lacrimal fistula The term Lacrimal or lachrymal, may refer to: Anatomy * Lacrimal apparatus * Lacrimal artery * Lacrimal bone * Lacrimal canaliculi (singular: canaliculus), also known as ''Lacrimal ducts'' * Lacrimal fossa (disambiguation) * Lacrimal fluid, see Te ...

* (H05.81)

Carotid cavernous fistula A carotid-cavernous fistula results from an abnormal communication between the arterial and venous systems within the cavernous sinus in the skull. It is a type of arteriovenous fistula. As arterial blood under high pressure enters the cavernous s ...

* (H70.1) Mastoid fistula ** Craniosinus fistula: between the

intracranial space The cranial cavity, also known as intracranial space, is the space within the skull that accommodates the brain. The skull minus the mandible is called the ''cranium''. The cavity is formed by eight cranial bones known as the neurocranium that in ...

and a

paranasal sinus Paranasal sinuses are a group of four paired air-filled spaces that surround the nasal cavity. The maxillary sinuses are located under the eyes; the frontal sinuses are above the eyes; the ethmoidal sinuses are between the eyes and the sphenoid ...

* (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 of the ears

I: Diseases of the circulatory system

* (I25.4) Coronary arteriovenous fistula, acquired * (I28.0)

Arteriovenous fistula An 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 ...

of pulmonary vessels **

Pulmonary arteriovenous fistula The lungs are the primary Organ (anatomy), organs of the respiratory system in humans and most other animals, including some snails and a small number of fish. In mammals and most other vertebrates, two lungs are located near the vertebral co ...

: between an artery and vein of the

lungs The lungs are the primary organs of the respiratory system in humans and most other animals, including some snails and a small number of fish. In mammals and most other vertebrates, two lungs are located near the backbone on either side of th ...

, resulting in shunting of blood. This results in improperly oxygenated blood. * (I67.1) Cerebral

, acquired * (I77.0)

, 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 pul ...

J: Diseases of the respiratory system

* (J86.0)

Pyothorax Pleural empyema is a collection of pus in the pleural cavity caused by microorganisms, usually bacteria. Often it happens in the context of a pneumonia, injury, or chest surgery. It is one of the various kinds of pleural effusion. There are three ...

with fistula * (J95.0)

Tracheoesophageal fistula A tracheoesophageal fistula (TEF, or TOF; see spelling differences) is an abnormal connection (fistula) between the esophagus and the trachea. TEF is a common congenital abnormality, but when occurring late in life is usually the sequela of surgica ...

, between the

trachea The trachea, also known as the windpipe, is a Cartilage, cartilaginous tube that connects the larynx to the bronchi of the lungs, allowing the passage of air, and so is present in almost all air-breathing animals with lungs. The trachea extends ...

and the

esophagus The esophagus (American English) or oesophagus (British English; both ), non-technically known also as the food pipe or gullet, is an organ in vertebrates through which food passes, aided by peristaltic contractions, from the pharynx to the ...

. This may be

congenital A birth defect, also known as a congenital disorder, is an abnormal condition that is present at birth regardless of its cause. Birth defects may result in disabilities that may be physical, intellectual, or developmental. The disabilities can ...

or acquired, for example as a complication of a

tracheostomy Tracheotomy (, ), or tracheostomy, is a surgical airway management procedure which consists of making an incision (cut) on the anterior aspect (front) of the neck and opening a direct airway through an incision in the Vertebrate trachea, trache ...

K: Diseases of the digestive system

* (K11.4)

Salivary gland fistula A salivary gland fistula (plural ''fistulae'') is a fistula (i.e. an abnormal, epithelial-lined tract) involving a salivary gland or duct. Salivary gland fistulae are almost always related to the parotid gland or duct, although the submandibular g ...

* (K31.6) Fistula of stomach and duodenum * (K31.6) Gastrocolic fistula * (K31.6) Gastrojejunocolic fistula – after a

Billroth II Billroth II, more formally Billroth's operation II, is an operation in which a partial gastrectomy (removal of the stomach) is performed and the cut end of the stomach is closed. The greater curvature of the stomach (not involved with the previo ...

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 Bad breath, also known as halitosis, is a symptom in which a noticeably unpleasant breath odour is present. It can result in anxiety among those affected. It is also associated with depression and symptoms of obsessive compulsive disorder. Th ...

. **

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 The 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 m ...

or the

jejunum The jejunum is the second part of the small intestine in humans and most higher vertebrates, including mammals, reptiles, and birds. Its lining is specialised for the absorption by enterocytes of small nutrient molecules which have been previous ...

or the

ileum The 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 ma ...

. 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: from the stomach to the skin surface * (K38.3)

Fistula of appendix A fistula (plural: fistulas or fistulae ; from Latin ''fistula'', "tube, pipe") in anatomy is an abnormal connection between two hollow spaces (technically, two epithelialized surfaces), such as blood vessels, intestines, or other hollow org ...

* () Anal and rectal fissures and fistulas ** ()

** () Anorectal fistula (fecal fistula, fistula-in-ano): connecting the

or other

anorectal Anorectal anomalies are congenital malformations of the anus and rectum. One anal anomaly, imperforate anus has an estimated incidence of 1 in 5000 births.MedLine Plus.Imperforate anus" Retrieved 13 July 2005. It affects boys and girls with simil ...

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 relati ...

through an opening other than the

anus 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, d ...

. * (K63.2) Fistula of intestine ** Enteroenteral fistula: between two parts of the intestine * (K82.3) Fistula of

gallbladder In vertebrates, the gallbladder, also known as the cholecyst, is a small hollow organ where bile is stored and concentrated before it is released into the small intestine. In humans, the pear-shaped gallbladder lies beneath the liver, although ...

* (K83.3) Fistula of

bile duct A bile duct is any of a number of long tube-like structures that carry bile, and is present in most vertebrates. Bile is required for the digestion of food and is secreted by the liver into passages that carry bile toward the hepatic duct. It ...

Biliary fistula A biliary fistula is a type of fistula in which bile flows along an abnormal connection from the bile ducts into nearby hollow structure. Types of biliary fistula include: * bilioenteric fistula: abnormal connection to small bowel, usually duodenu ...

: connecting the bile ducts to the skin surface, often caused by gallbladder surgery **

Pancreatic fistula A 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 kn ...

: 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 end ...

and the exterior via the

abdominal wall In anatomy, the abdominal wall represents the boundaries of the abdominal cavity. The abdominal wall is split into the anterolateral and posterior walls. There is a common set of layers covering and forming all the walls: the deepest being the v ...

M: Diseases of the musculoskeletal system and connective tissue

* (M25.1) Fistula of

joint A joint or articulation (or articular surface) is the connection made between bones, ossicles, or other hard structures in the body which link an animal's skeletal system into a functional whole.Saladin, Ken. Anatomy & Physiology. 7th ed. McGraw ...

N: Diseases of the urogenital system

* (N32.1) Vesicointestinal fistula * (N36.0)

Urethral fistula The urethra (from Greek language, Greek οὐρήθρα – ''ourḗthrā'') is a tube that connects the urinary bladder to the urinary meatus for the removal of urine from the body of both females and males. In human females and other primates, ...

** Innora:between the

prostatic utricle The prostatic utricle (Latin for "small pouch of the prostate") is a small indentation in the prostatic urethra, at the apex of the urethral crest, on the seminal colliculus (''verumontanum''), laterally flanked by openings of the ejaculatory duc ...

and the outside of the body * (N64.0)

Fistula of nipple A fistula (plural: fistulas or fistulae ; from Latin ''fistula'', "tube, pipe") in anatomy is an abnormal connection between two hollow spaces (technically, two epithelialized surfaces), such as blood vessels, intestines, or other hollow org ...

* (N82) Fistulae involving female genital tract /

Obstetric fistula Obstetric fistula is a medical condition in which a hole develops in the birth canal as a result of childbirth. This can be between the vagina and rectum, ureter, or bladder. It can result in incontinence of urine or feces. Complications may inc ...

** (N82.0)

Vesicovaginal fistula Vesicovaginal fistula (VVF) is a subtype of female urogenital fistula (UGF). Presentation Vesicovaginal fistula, or VVF, is an abnormal fistulous tract extending between the bladder ('' vesica'') and the vagina that allows the continuous involu ...

: between the

and the

** (N82.1) Other female urinary-genital tract fistulae *** Cervical fistula: abnormal opening in the

cervix The cervix or cervix uteri (Latin, 'neck of the uterus') is the lower part of the uterus (womb) in the human female reproductive system. The cervix is usually 2 to 3 cm long (~1 inch) and roughly cylindrical in shape, which changes during ...

** (N82.2)

Fistula of vagina to small intestine A fistula (plural: fistulas or fistulae ; from Latin ''fistula'', "tube, pipe") in anatomy is an abnormal anastomosis, connection between two hollow spaces (technically, two epithelium, epithelialized surfaces), such as blood vessels, intestin ...

*** Enterovaginal fistula: between the

and the vagina ** (N82.3) Fistula of vagina to large intestine ***

Rectovaginal The rectouterine pouch (recto-uterine pouch), pouch of Douglas, or rectovaginal pouch is the extension of the peritoneum between the rectum and the posterior wall of the uterus in the human female. Its anterior boundary is formed by the posterior ...

: between the

and the vagina ** (N82.4) Other

female intestinal-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 ...

** (N82.5)

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

** (N82.8) Other female genital tract fistulae ** (N82.9) Female genital tract fistula, unspecified

Q: Congenital malformations, deformations and chromosomal abnormalities

* (Q18.0)

Sinus Sinus may refer to: Anatomy * Sinus (anatomy), a sac or cavity in any organ or tissue ** Paranasal sinuses, air cavities in the cranial bones, especially those near the nose, including: *** Maxillary sinus, is the largest of the paranasal sinuses, ...

, fistula and cyst of

branchial cleft A pharyngeal groove (or branchial groove, or pharyngeal cleft) is made up of ectoderm unlike its counterpart the pharyngeal pouch (embryology), pharyngeal pouch on the endodermal side. The first pharyngeal groove produces the external auditory mea ...

Congenital A birth defect, also known as a congenital disorder, is an abnormal condition that is present at birth regardless of its cause. Birth defects may result in disabilities that may be physical, intellectual, or developmental. The disabilities can ...

preauricular fistula: A small pit in front of the

ear An ear is the organ that enables hearing and, in mammals, body balance using the vestibular system. In mammals, the ear is usually described as having three parts—the outer ear, the middle ear and the inner ear. The outer ear consists of ...

. Also known as an ear pit or preauricular sinus. * (Q26.6)

Portal vein The portal vein or hepatic portal vein (HPV) is a blood vessel that carries blood from the gastrointestinal tract, gallbladder, pancreas and spleen to the liver. This blood contains nutrients and toxins extracted from digested contents. Approxima ...

hepatic artery The common hepatic artery is a short blood vessel that supplies oxygenated blood to the liver, pylorus of the stomach, duodenum, pancreas, and gallbladder. It arises from the celiac artery and has the following branches: Additional images ...

fistula * (Q38.0) Congenital fistula of lip * (Q38.4) Congenital fistula of

salivary gland The salivary glands in mammals are exocrine glands that produce saliva through a system of ducts. Humans have three paired major salivary glands (parotid, submandibular, and sublingual), as well as hundreds of minor salivary glands. Salivary gla ...

* (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 i ...

and

stenosis A stenosis (from Ancient Greek στενός, "narrow") is an abnormal narrowing in a blood vessel or other tubular organ or structure such as foramina and canals. It is also sometimes called a stricture (as in urethral stricture). ''Stricture'' ...

with fistula * (Q42.2) Congenital absence,

and

with fistula * (Q43.6) Congenital fistula of

and

* (Q51.7) Congenital fistulae between

and digestive and

s * (Q52.2) Congenital

T: External causes

* (T14.5) Traumatic arteriovenous fistula * (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 company ...

Causes

* Disease: Infections including an

anorectal abscess Anorectal abscess (also known as an anal/rectal abscess, or perianal/perirectal abscess) is an abscess adjacent to the anus. Most cases of perianal abscesses are sporadic, though there are certain situations which elevate the risk for developin ...

and inflammatory diseases including

Crohn's disease Crohn's disease is a type of inflammatory bowel disease (IBD) that may affect any segment of the gastrointestinal tract. Symptoms often include abdominal pain, diarrhea (which may be bloody if inflammation is severe), fever, abdominal distension ...

and

ulcerative colitis Ulcerative colitis (UC) is a long-term condition that results in inflammation and ulcers of the colon and rectum. The primary symptoms of active disease are abdominal pain and diarrhea mixed with blood (hematochezia). Weight loss, fever, and a ...

can result in fistulas. Fistulas to the anus may occur in

hidradenitis suppurativa Hidradenitis suppurativa (HS), sometimes known as acne inversa or Verneuil's disease, is a long-term dermatological condition characterized by the occurrence of inflamed and swollen lumps. These are typically painful and break open, releasing ...

. In women, fistulas can also occur following pelvic infection and inflammation. Probed gastrocutaneous fistula tract

* Surgical and medical treatment: Complications from

surgery can lead to biliary fistulas. As well as being congenital or resulting from trauma,

s are created purposefully for

. Radiation therapy to the pelvis can lead to vesicovaginal fistulas. Persistent gastrocutenaous fistulas can develop after

gastrostomy Gastrostomy is the creation of an artificial external opening into the stomach for nutritional support or gastric decompression. Typically this would include an incision in the patient's epigastrium as part of a formal operation. It can be perfor ...

. * 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 Obstetric fistula is a medical condition in which a hole develops in the birth canal as a result of childbirth. This can be between the vagina and rectum, ureter, or bladder. It can result in incontinence of urine or feces. Complications may inc ...

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

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 developed fistulae. In 2003, thousands of women in eastern Congo 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 Pus is an exudate, typically white-yellow, yellow, or yellow-brown, formed at the site of inflammation during bacterial or fungal infection. An accumulation of pus in an enclosed tissue space is known as an abscess, whereas a visible collection ...

may escape without forming an

abscess An abscess is a collection of pus that has built up within the tissue of the body. Signs and symptoms of abscesses include redness, pain, warmth, and swelling. The swelling may feel fluid-filled when pressed. The area of redness often extends b ...

). Various surgical procedures are used, most commonly

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 in a ''seton''; a cord passed th ...

, 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

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 Kidney failure, also known as end-stage kidney disease, is a medical condition in which the kidneys can no longer adequately filter waste products from the blood, functioning at less than 15% of normal levels. Kidney failure is classified as eit ...

, requiring dialysis, a

cimino fistula A Cimino fistula, also Cimino-Brescia fistula, surgically created arteriovenous fistula and (less precisely) arteriovenous fistula (often abbreviated AV fistula or AVF), is a type of vascular access for hemodialysis. It is typically a surgically cr ...

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 Portal hypertension is abnormally increased portal venous pressure – blood pressure in the portal vein and its branches, that drain from most of the intestine to the liver. Portal hypertension is defined as a hepatic venous pressure gradient gr ...

, surgical creation of a portacaval fistula produces an anastomosis between the

hepatic portal vein The portal vein or hepatic portal vein (HPV) is a blood vessel that carries blood from the gastrointestinal tract, gallbladder, pancreas and spleen to the liver. This blood contains nutrients and toxins extracted from digested contents. Approxima ...

and the

inferior vena cava The inferior vena cava is a large vein that carries the deoxygenated blood from the lower and middle body into the right atrium of the heart. It is formed by the joining of the right and the left common iliac veins, usually at the level of the ...

across the omental foramen (of Winslow). This spares the portal venous system from high pressure which can cause esophageal varices,

caput medusa Caput medusae is the appearance of distended and engorged superficial epigastric veins, which are seen radiating from the Navel, umbilicus across the abdomen. The name ''caput medusae'' (Latin language, Latin for "head of Medusa") originates fro ...

e, 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

to refer to species that are distinguished by hollow or tubular structures. ''

Monarda fistulosa ''Monarda fistulosa'', the wild bergamot or bee balm,Wild Bergamot
, Edmonton Naturalization Group< ...

'', for example, has tubular flowers; ''

Eutrochium fistulosum ''Eutrochium fistulosum'' (''Eupatorium fistulosum''), also called hollow Joe-Pye weed, trumpetweed, or purple thoroughwort, is a perennial North American flowering plant in the family Asteraceae. It is native to southern Canada and throughout ...

'' has a tubular stem; ''

Allium fistulosum ''Allium fistulosum'', the Welsh onion, also commonly called bunching onion, long green onion, Japanese bunching onion, and spring onion, is a species of perennial plant, often considered to be a kind of scallion. The species is very similar ...

'' 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

Definition

Classification

Location

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

I: Diseases of the circulatory system

J: Diseases of the respiratory system

K: Diseases of the digestive system

M: Diseases of the musculoskeletal system and connective tissue

N: Diseases of the urogenital system

Q: Congenital malformations, deformations and chromosomal abnormalities

T: External causes

Causes

Treatment

Therapeutic use

Epidemiology

Botany

Society and culture

See also

References

External links