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Open Gastrointestinal Fistula Surgery

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Endoscopic Gastrointestinal Fistula Surgery

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Open Gastrointestinal Fistula Surgery

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Endoscopic Gastrointestinal Fistula Surgery

Overview

An aberrant opening in your stomach or intestines that allows gastric fluid to flow through the lining, is called a gastrointestinal fistula (GIF) . When such fluids leak into your skin or other organs, it could result in infections. Read the article in detail to learn more about the gastrointestinal fistula, its symptoms, causes, diagnosis, and treatment. 

What Is A Gastrointestinal Fistula?

A gastrointestinal fistula (GIF) is an abnormal passage in the digestive tract. This connection or passageway that develops between two parts of the gastrointestinal tract or between the gastrointestinal tract and another organ or tissue in the body allows the contents of one part of the digestive system to leak into another part, which can cause a variety of health problems. A gastrointestinal fistula may also be referred to as an intestinal or enterocutaneous fistula by medical professionals. The types, causes, symptoms, diagnosis, remedies, and side effects of a gastrointestinal fistula will be covered in this article.

What Are The Types Of Gastrointestinal Fistula?

  • Intestinal fistula: An intestinal fistula is also known as a "gut-to-gut" fistula. An abnormal opening is formed between the folds of the intestine. Here, the gastric fluid seeps into another part of the intestine.
  • Extraintestinal fistula: The fistula forms between the intestine and other surrounding organs, such as the bladder, vascular system (blood vessels), or lungs, thus allowing the gastric fluid to leak into these organs.
  • External fistula: Also called the "cutaneous fistula," this fistula connects a part of the gastrointestinal tract to the skin, and the gastric fluid seeps into the skin.
  • Complex fistula: They may involve multiple connections between different parts of the gastrointestinal tract or between the gastrointestinal tract and other organs or tissues in the body.

What Are The Causes Of Gastrointestinal Fistula ?

These are the possible causative agents for GIF (gastrointestinal fistula).

  • Surgical complications: Among gastric fistula causes, this is the most common. Between 85 and 90% of all gastrointestinal fistulas result from surgical complications. After having abdominal surgery, most patients develop fistulae as a result of significant tissue damage and the majority of fistulae develop in the first week following surgery . Before having abdominal surgery, you should always talk to your doctor about the complications and risk factors involved with the surgery.
  • Infection: An infection like diverticulitis (inflammation of the small pouches that can form in the colon) may lead to the development of a fistula. Diverticulitis can develop when stool becomes trapped in the pouches, causing inflammation and, in some cases, infection. In severe cases, diverticulitis can lead to complications such as abscesses, perforations, or fistulas. Other infections, such as tuberculosis or abscesses, can also erode through the intestinal wall and cause fistula formation.
  • Inflammatory diseases: Inflammatory bowel diseases, such as Crohn’s disease and ulcerative colitis, are inflammatory conditions that can cause inflammation and damage to the lining of the digestive tract.  As many as 40% of people with these bowel conditions develop a fistula at some point in their lives.
  • Trauma: A gastrointestinal fistula can also develop due to physical trauma, such as gunshots or knife wounds that puncture the abdomen.
  • Spontaneous GIF formation: Gastrointestinal fistulas can occasionally develop without apparent explanation. In this case, it's called a spontaneous formation.
  • Cancer and treatment: A history of cancer or of receiving radiation in the abdomen, for example, as part of cancer treatment, may also increase the risk of a gastrointestinal fistula. 
  • Ulcer: Having an ulcer in the gut also places you at an increased risk of developing a gastrointestinal fistula. 

Lastly, a blockage in the intestine or swallowing caustic substances such as lye could also lead to the development of a gastrointestinal fistula. 

What Are The Symptoms Of Gastrointestinal Fistula?

The symptoms of a gastrointestinal fistula can vary depending on the location of the fistula, the organs involved, and the underlying cause. Some common symptoms of gastrointestinal fistula include:

  • An abnormal drainage of pus, stool, or other fluids from an opening in the skin or other part of the body.
  • Persistent abdominal pain, particularly if the pain is associated with eating or bowel movements.
  • Diarrhea or fecal incontinence.
  • Fever, chills, and other signs of infection.
  • Unexplained weight loss or malnutrition.
  • Nausea and vomiting.
  • Foul-smelling breath or body odor due to the presence of digestive fluids in the respiratory tract or skin.
  • Dehydration and electrolyte imbalances due to fluid loss.
  • Skin irritation and inflammation around the site of the fistula.

If you experience any of these symptoms, it is important to see a healthcare provider for evaluation and appropriate treatment. A gastrointestinal fistula can cause significant complications, including infections, abscesses, and sepsis if left untreated.

What Are The Methods For The Diagnosis Of Gastrointestinal Fistula?

The following are the methods available for the diagnosis of gastrointestinal fistula.

  • Medical history: While diagnosing a gastrointestinal fistula, a doctor will consider a patient's medical history A person has a higher risk of developing a fistula if they have undergone particular surgical procedures in the past, such as gynecological surgery. The doctor will also discuss your symptoms, including when the fistula first appeared and whether anything helped or made them worse.

If the doctor suspects a gastrointestinal fistula, he or she will order diagnostic procedures to confirm the diagnosis. These tests could consist of:

  • Barium studies: The patient receives barium orally or through an enema before taking an X-ray. The barium may reveal signs of leaking, which will confirm the presence of a fistula.
  • Fistulogram: A fistulogram is a diagnostic procedure in which a dye is injected into the affected portion or opening of the skin in an affected fistula. The X-ray images taken later will reveal any fistula obstructions.
  • Imaging scans: To determine the fistula’s size and location, the doctor uses an imaging scan, like a computed tomography (CT)  scan. This is crucial so that surgeons can choose where to operate and perform drainage of the fistulas. 
  • Endoscopy: An endoscopy is a technique that uses a tube-like instrument with a light and camera at the end to see inside your digestive tract for gastrointestinal fistulas. Endoscopy makes it easy for a medical professional to examine your internal condition.
  • Blood tests: The doctor may also recommend blood tests to assess your serum electrolytes and nutritional status. The levels of the proteins albumin and pre-albumin can help determine the capacity of wound healing in the body.

What Are the Treatment Methods Available For Gastrointestinal Fistula?

 The treatment methods for gastrointestinal fistula purely depend upon the severity and location of the fistula and include:

  • Wait and watch approach: Small, uninfected fistulae frequently close on their own. In many cases, gastrointestinal fistulae are known to heal by themselves in 30 to 50 days. The doctor often waits for a period of time to let your body heal itself. During this time, your symptoms are monitored, and if the doctor notices no improvement or worsening of the symptoms, then he/she will frame a suitable treatment plan. In most cases, the “wait and watch” treatment method focuses on keeping the patient well-nourished and preventing infection by replenishing fluids, correcting blood serum electrolytes to normalize the acid and base imbalance, reducing the fluid output from the fistula, guarding against sepsis, and protecting your skin. 
  • Medications: The use of medications for the treatment of gastrointestinal fistula depends on the underlying cause of the fistula and any associated conditions. Medications maybe prescribed to treat infections and control inflammation. Some of the medications used in treating gastrointestinal fistulas include antibiotics, proton-pump inhibitors, NSAIDs and nutritional supplements. 
  • Surgical methods: In the case of sepsis, the doctor would generally recommend gastrointestinal fistula surgery to repair the areas of drainage.
    • Negative pressure therapy: It is a minimally invasive method that makes use of negative pressure. Here a special dressing is applied in the area of the fistula that creates a vacuum around the site. This helps close the fistula and prevent further complications by increasing the blood flow and promoting the growth of new tissues. 
    • Endoscopic techniques: Sometimes your surgeon may use an endoscope to treat a fistula. In these cases, a scope (a thin flexible tube with an attached light and camera) is inserted into the rectum and up to the abdominal region. Glue or clips can be inserted via an endoscope to clamp and close the fistula.

What Are The Complications Associated With Gastrointestinal Fistula?

A gastrointestinal fistula can result in a number of complications, such as

  • Sepsis: In rare cases, gastrointestinal fistulas may lead to a fatal condition called sepsis. Here the infection enters the bloodstream and spreads throughout the body. Sepsis is one of the significant complications of gastrointestinal fistula. 
  • Electrolyte imbalances: There is a loss of intestinal fluids in the case of gastrointestinal fistulas. This can result in dehydration and electrolyte imbalances.
  • Malnutrition: Fistulas can prevent the absorption of nutrition from your gut eventually resulting in malnutrition.
  • Bowel obstruction: Fistulas can cause partial or complete bowel obstruction, which can be life-threatening if left untreated.
  • Abscess formation: Fistulas can lead to abscess formation in the surrounding tissue.

What Are The Methods Of Prevention of Gastrointestinal Fistula?

It may not be possible to prevent all cases of gastrointestinal fistulas. The prevention of gastrointestinal fistula depends on the severity and cause of the fistula. You can include these measures in your life: 

  • Have a healthy and fiber-rich diet to improve your digestion.
  • Manage the bowel diseases that increase the risk of developing a gastrointestinal fistula, such as Crohn's disease or diverticulitis.
  • Avoid prolonged use of medications that can damage the lining of the digestive tract.
  • Quit smoking, as it can impair wound healing.
  • Exercise regularly to keep your entire body and digestive system healthy.
  • Get timely treatment for any abdominal injuries or infections that may lead to the development of a gastrointestinal fistula.
  • Prevent infections that may increase the risk of a gastrointestinal fistula by maintaining hygienic practices.

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