Intestinal fistula is a pathological hole in the wall that connects to a hollow organ or body surface. Intestinal fistulas are internal and external. In the first case, they rarely manifest themselves as characteristic symptoms. As for the external ones, they are diagnosed if there is a channel on the skin through which stool and gases pass. In addition, the patient dramatically loses weight, he has a syndrome of multiple organ failure. To make a final diagnosis, an x-ray, endoscopic and laboratory examination is prescribed. Non-surgical methods of therapy are appropriate for tubular fistulas, as well as at the time of the preparatory stage for operations with spongy fistulas.
More about the disease
Intestinal fistula is a pathology that intensively progresses due to an increase in the number of inflammatory processes in the intestine. The latter most often entail the formation of unnatural communications. This ailment can have an innate, acquired and artificial form. The first surgery for a fistula in the intestine was performed in the 18th century. In modern medicine, different methods of surgical treatment of such a pathology are used.
Causes
The main reasons for the appearance of the fistula include necrosis of intestinal tissues caused by a local violation of the outflow of blood. Such consequences are usually caused by diseases that occur with inflammation. These include: acute appendicitis, tumors, intestinal tuberculosis. Sometimes a fistula is formed in connection with a violation of the blood flow and nutrition of intestinal tissues. Fistulas of the intestines can also be the result of penetrating and blunt injuries of the abdomen.
The most basic causes of maturation of the fistula include complications that appeared after surgery. An infrequent cause of the appearance of such a pathology is a violation of embryonic growth. Fistulous passages that appear between the intestines and other organs, entail serious violations in the body. The pathogenetic mechanism of the development of multiple organ failure syndrome (PON) is related to the loss of stomach or intestines, problems associated with the absorption of nutrients, intoxication, which appears due to inflammation in the fistula.
Fistulas of the small intestine are considered the most dangerous, since up to 10 liters of fluid can flow through them per day, which leads to dehydration and loss of digestive juices and enzymes. Against the background of dehydration, there is a loss of blood, which passes through the channels of the kidneys. Aldosterone production intensifies, as a result of which potassium is actively washed away. In addition, the process of absorption of biologically significant elements of the intestine is disrupted.
Initially, the body’s energy resources are covered by splitting glycogen reserves in the liver and muscles, after which catabolism processes, which involve the consumption of protein and fat reserves, are launched. Against the background of excessive dissimilation, cell decay is observed, which entails the accumulation of potassium, toxic metabolic waste. As a result of such phenomena, the kidneys are exposed to special stress. Depletion and PON develop, which leads to death in 40%.
Fistula in the large intestine and the one that forms in the small section do not often entail obvious dystrophic disturbances. A large amount of nutrients and fluids are absorbed in the upper part of the small intestine. That is why the loss of fluid at the level of the distal digestive tube does not entail serious dehydration, lack of nutrients and depletion of the patient's body. A serious problem with low intestinal fistulas is a pathological condition in which the mucous membrane of the intestinal outlet section suffers.
Types of intestinal fistula
Fistulas of the intestine are divided into congenital and acquired. The first option is extremely rare. As a rule, this pathology is due to insufficient development of the intestinal tube or cleft of the intestinal cystic duct. As for the acquired form, almost half of all cases that are known to medical practice are associated with complications that appeared after the operation. The acquired species also include fistulas that are created artificially. Such holes are made for the purpose of enteral nutrition, unloading the organ with peritonitis, tumor formations, intestinal obstruction.
According to the type of compound, intestinal fistulas are divided into:
The internal fistula communicates the intestinal cavity with organs such as the uterus, bladder. They can also join other parts of the intestine. For the external type, opening on the surface of the skin is characteristic. The fistulous passages of a mixed form have access to other organs and to the skin. In addition, intestinal fistulas can be formed and unformed. The first option includes passages that have an opening in the wound of the abdominal wall or purulent cavity, as well as those that are devoid of fistulous passage due to the fact that they are attached to the intestinal mucosa and skin.
The openings of the formed type are characterized by the presence of a fistulous passage, which is lined with tissue covering the surface of the body cavity. Such a plan of fistulas can have different passages that differ in length, width and shape. Fistulas are also single and multiple. Depending on the content, they are divided into full and incomplete. In the first case, the fluid leaves the intestine in such a way that it does not fill the outlet loop. With such fistulas, an intestinal spur is observed, which can be real or false. As for incomplete fistulas, with such a pathology, the contents of the organ do not come out fully.
Symptoms
Symptoms of an intestinal fistula depend on their location, characteristics, and period of appearance. The course of the disease with fistulas of the formed type is considered easier. For this species, the presence of severe symptoms is not characteristic. With unformed fistulas, intoxication is observed, which is caused by inflammation in the area of the mouth of the fistulous passage.
Photos of the intestinal fistula can be easily found in specialized medical literature. With this pathology, you must definitely contact the doctors.
If we talk about the internal inter-intestinal fistulas, then they may not make themselves felt for a long period. Against the background of intestinal-uterine and intestinal-vesiculate fistulas, stool seeps through the vagina, it is also found in urine at the time of the emptying of the bladder. With a fistula in the large intestine, the following symptoms are observed:
- severe diarrhea;
- significant weight loss.
For external fistulas, certain clinical features are characteristic, which depend on their location. With high small intestinal fistulas, a defect appears on the skin through which an outflow of intestinal contents of yellow color occurs, including gastrointestinal tract juices, bile, and food chyme. Around the cavity, dermatitis often develops. Loss of fluid through a high fistula of the small intestine entails the development of PON and a significant deterioration in the patient's condition. He can lose weight by 50%, with time he will develop serious exhaustion, depression.
As for the low fistulas that develop in the large intestine, they are not characterized by the loss of fluid in a large volume. If we take into account the fact that feces in this area have already been formed, we conclude that a violation of the integrity of the epidermis and dermatitis will not develop. Violations of the water-electrolyte balance, bleeding, exhaustion, etc. can be considered to be common complications of fistulas in the intestine.
Diagnostics
If such a pathology is suspected, a visit to a gastroenterologist and surgeon will be required. Doctors will conduct a visual examination and palpation of the fistula. After the examination, the specialist will be able to confirm the presence or absence of the fistulous course, determine its shape. In the future, other diagnostic measures will be prescribed to the patient. To find out where the pathological opening is located, fluid from the fistulous passage is taken as the material for analysis. This is done to identify bilirubin, bile acids, and enzymes produced by the pancreas in it.
In addition, they carry out tests with dyes. If there is a suspicion of a fistula of the small intestine, the patient consumes methylene blue inside. If a fistula is found in the large intestine, the drug is administered through an enema. Depending on the period of occurrence of the dye in the emitted liquid from the hole, the exact location is determined. To find out what condition the internal organs are in and whether they are associated with the fistulous canal, the patient is prescribed an ultrasound of the abdominal organs, radiography and tomography of this area.
In addition, the doctor may decide to send the patient for irrigoscopy or fistulography, endoscopy. These diagnostic methods allow you to conduct a full examination of the internal mouth of the fistula, to find out if the intestinal mucosa has suffered and whether there is a true or false spur.
Treatment
Treatment of fistulas in the intestine is carried out in a hospital. If high small intestinal fistulas have been identified, the patient is placed in intensive care or in the surgery department. Patients who have large intestinal fistulas that are asymptomatic are referred to gastroenterology or prescribe home therapy. At the initial stage of treatment, conservative manipulations are carried out, which include filling the lack of fluid, normalizing the ion-electrolyte state.
When a wound with purulent contents, an abscess or dermatitis was found in the area of the fistulous course, the patient undergoes eradication of the infection area and detoxification procedures. Local therapy is based on the use of dressings soaked in hypertonic or enzyme solution. Ointments and pastes with an antiseptic effect are applied to pathological areas. The skin is also protected from fluid that is separated from the intestine. The principle of physical protection is to create a barrier between the skin and the organs that are discharged. For this purpose, paste, BF 1, BF 2 glue, polymer films are used.
Protection in a biochemical way consists in wrapping the mouth of the fistulous passage with napkins soaked in milk, lactic acid or raw egg white. For mechanical blockade, devices are used in the form of an aspirator and an obturator, which does not allow intestinal contents to stand out. In order to neutralize pancreatic and gastric juice, histamine receptor blockers, proteases can be involved.
At the time of conservative therapy, it is extremely important to adhere to certain rules of nutrition. With the help of conservative treatment methods, the formed fistula is delayed after 1-2 months of regular performance of all procedures.
Surgical removal
Surgery for intestinal fistula is prescribed for ineffective therapy. Surgical intervention is also resorted to with fistulas of the descending branch of the duodenum, which is caused by the failure of the biliodigestive anastomosis or injuries, which are characterized by the loss of bile and intestinal contents in large volumes.
The surgical method of removing lip-shaped intestinal fistulas is resorted to if they are not delayed for a long period. With fistulas that have an incomplete tubular or lip-shaped form, extraperitoneal methods of their closure are appropriate. To eliminate all other types of fistulas, a laparotomy method is prescribed.
If lip-shaped fistulas of the colon have been diagnosed, an operation may be prescribed, the method of which depends on the type of fistula (full or incomplete). With incomplete lip-shaped fistulas, which are small in size, resort to extra-abdominal options for their closure. This method involves the isolation of the intestinal wall in the fistula and stitching the opening with a two-row suture.
With large incomplete and complete fistulas of the lip-shaped appearance, the use of intra-abdominal removal methods is prescribed. To do this, the intestine is excreted along the entire perimeter of the pathological opening, it is removed into the wound and the fistula is sutured, if it is incomplete. With a full fistula, an anastomosis is applied. If fistulas were found in large numbers, which are located on the same intestinal loop, it is resected and an anastomosis is applied.
Folk remedies
If a fistula of the small intestine has been detected, a folk remedy can be included in a comprehensive treatment regimen. They have a therapeutic effect and help eliminate inflammation. With fistulas of the rectum, you can use one of the following recipes:
- Combine vodka and olive oil in equal proportions. Wipe the composition with a sore spot several times a day. After the procedure, apply a sheet of cabbage to the fistula.
- Mix in a ratio of 1: 1 mummy and juice from aloe leaves. Moisten a bandage in the fluid and apply a bandage to the affected area.
- Put in a container of 2 tbsp. l dry hypericum, pour 400 ml of water. Bring the composition to a boil. Cool the resulting broth, then strain. Apply a bandage dampened in herbal infusion to the fistula site.
- Take in equal proportions the oak bark, water pepper grass, flaxseed flowers, pour the raw materials with melted lard and warm. As a part, moisten a cotton swab and attach to the place with a fistula.
Forecast and Prevention
The fatal outcome after surgery of the intestinal fistula is 2-10%. It all depends on the form in which the fistula itself was, as well as on the condition of the patient before surgery. As a rule, deaths are associated with sepsis and renal failure. If the fistulous course is detected in time, through competent treatment, you can affect its spontaneous delay. As for preventive measures, they consist in the timely diagnosis and treatment of background diseases, which entail the formation of fistulous passages.
Conclusion
It is easier to get rid of the fistula in the early stages of its appearance. It is extremely dangerous to treat the fistula of the small intestine on its own, since this pathology can lead to serious consequences. In order for the outcome to be favorable, it is extremely important to contact the doctors on time.