Fistula repair or surgery aims to correct an abnormal tubular connection between internal organs or vessels within the body.
Types of Fistulas
Fistulas typically arise from inflammation or infection resulting from injury or surgical procedures. Several types of fistulas include:
Anal or perianal fistulas, which may develop between:
- The colon and vagina
- The rectum or anus and vagina
- The anal canal and anal opening
Urinary tract fistulas, which can arise between:
- The urethra and vagina
- The bladder and vagina
- The bladder and uterus
Gastrointestinal fistulas, which occur between:
- A segment of the gastrointestinal tract and the skin
- Two sections of the intestine
- A part of the intestine and another organ in the body, such as the bladder
Aortoenteric fistulas, which form between:
The native aorta and the duodenum or jejunum or between a prosthetic aortic graft and any segment of the gastrointestinal tract
Fistula Symptoms
Symptoms of anal fistulas may include:
- Difficulty with bowel control
- Throbbing pain
- Foul-smelling discharge near the anus
- Presence of blood during bowel movements
- Skin inflammation around the anal region
- Elevated body temperature, particularly if an abscess forms
- Inflammation and redness surrounding the anus
Urinary tract fistulas might exhibit the following symptoms:
- Abdominal discomfort
- Vulva irritation
- Passing gas through the urethra during urination
- Fecal matter seeping into the vagina
- Foul-smelling gas or discharge from the vagina
- Discharge or urine leakage from the vagina
- Frequent urinary tract infections (UTIs)
Gastrointestinal fistula sufferers may experience:
- Abdominal pain
- Elevated body temperature
- Diarrhea
- Dehydration
- Vomiting
- Increased heart rate
- Malnourishment
Causes of Fistulas
Inflammation or trauma occurring within the body may result in the formation of fistulas. Fistulas may be caused by:
- HIV infection
- Surgical procedures
- Ulcerative colitis
- Tuberculosis
- Hidradenitis suppurativa
- Physical trauma
- Abdominal radiation therapy
- Diverticulitis
- Crohn’s disease
- Childbirth complications or prolonged labor
Fistula Diagnosis
Diagnosing fistulas typically involves a comprehensive pelvic examination by the physician to pinpoint the source of pelvic discharge. To determine the origin of the fluid leakage, the physician might employ a dye.
In a double dye examination, the patient may ingest a pill to tint urine orange and have a blue dye introduced into the bladder. Subsequently, the patient inserts a tampon into the vagina. A blue hue on the tampon indicates a vesicovaginal fistula, connecting the bladder and vagina, while an orange hue suggests a ureterovaginal fistula, linking the ureter and vagina.
Fistula Repair
Surgical treatment may be necessary for certain fistulas if a bladder catheter is insufficient.
For anal fistulas, patients may need surgical interventions such as fistulotomy and seton surgery. During fistulotomy, the surgeon cuts the entire length of the fistula, while seton surgery involves inserting a thin surgical thread into the fistula to facilitate drainage of any infection and promote healing.
Other treatments for fistulas include:
- Advancement flap procedure
- Endoscopic ablation
- Application of medical glue to seal the fistula
In fistula repair surgery, the surgeon typically makes an incision to access the fistula. Hospitalization is required both before and after the procedure for preparation and recovery. Following surgery, patients may need to utilize a bladder catheter for a period of 10-14 days.