Intestinal Fistula Treatments in Coimbatore

Intestinal Fistula

A fistula is an anomalous communication between two surfaces. Fistulae are named according to the organs or surfaces connected. An intestinal fistula is a fistula that begins from the intestine. Through fistula formation, it can connect to multiple organs or surfaces. It is not a condition on its own, rather a complication of certain conditions.

Causes of Intestinal Fistula

Intestinal fistula is commonly formed as a complication of an injury or surgery. Their common causes are:

• Surgical procedure: It is dependent on factors such as surgeons' skill, patient population, the disease for which the patient is undergoing the surgery, and the complexity of the surgery. 

Surgical procedures are responsible for 50 percent of the intestinal fistulae formation.

• Diverticular disease: Complex diverticular disease (formation of small bulging pouches in the digestive system lining) to contribute commonly to the formation of the fistula with an intra-abdominal organ such as the bladder. 

This happens because of the erosion of the diverticular wall and factors causing inflammation. 

• Crohn's disease: It is an example of inflammatory bowel diseases, which to are responsible for intestinal fistula formation.
• Malignancy: Intestinal cancer or cancer of the adjacent organs contributes to fistula formation. 
• Radiation: A portion of the intestine undergoing radiation treatment over a period of time with delayed recovery and slow healing, is susceptible to fistula formation. 

Non-surgical injuries and the presence of foreign bodies: These involve injuries acquired in abdominal trauma of some kind tend to increase the chances of fistula formation.

Symptoms of Intestinal Fistula

Depending on the organs impacted and involved in fistula formation numerous symptoms come into interplay, such as:

• Abdominal pain
• Fever
• Diarrhea
• Gastrointestinal bleeding
• Weakness
• Loss of appetite
• Weight loss
• Extreme weight loss and muscle wasting (cachexia)

When other adjacent organs get involved in fistula formation, the following symptoms are added to the list:

• Urinary tract infection
• Fecaluria
• Vaginal pain, discharge, or repeated infections

In cases where the skin gets involved in fistula formation:

• Pain in the area of skin involved in fistula formation.
• Irritable skin

Diagnosis for Intestinal Fistula

An intestinal fistula is a result of complications. The appropriate diagnosis of a fistula involves the following parameters:

• Confirming diagnosis based on symptoms.
• Identifying the location, size, and complexity of the fistula.
• The pathology of the fistula.
• Approach to managing the fistula.
• Once managed the plan for follow-up.

Having met with these metrics and the presented symptoms, the doctor may consider either of the imaging techniques for evaluation:

• GI contrast imaging, which travels the entire length of the fistula and goes to the other side, thus confirming the expanse of the fistula.

 In some cases, only the organs involved in fistula formation get confirmed. Here, a contrast enema or small-bowel follow-through gives better details of the fistula.

• A CT scan often is prescribed for the abdominopelvic region, which gives accurate details of fistula formation.

 Further, an MRI is sorted only when the formed fistulae are complex, like the ones formed in the case of Crohn's disease.

• Endoscopy of various regions in the intestine too can provide information about fistula formation. Reddening in the intestinal tract or an elevation is suggestive of fistula formation. For small fistulae, its lumen is difficult to visualize during an endoscopy.

 This technique generally is to identify the underlying cause of fistula formation, like intestinal cancer or Crohn's disease.

Treatment options for Intestinal Fistula

Non-surgical Treatment

Treatment by conservative measures is considered in high-risk patients where fibrin glue or occlusive methods are used. 

Other conservative treatment modalities include management and alleviation of symptoms presented because of the fistula formation.

Surgical Treatment

Operative procedures are carried out when the diagnosis of the fistula is generally accurate. This procedure involves excising the fistula and reinstating the linings of the respective organs involved in fistula formation.

Removal of all the unhealthy tissue involved in fistula formation and healing of the healthy, viable tissue sutured together at their ends is necessary for the healing of the fistula.  

The operating surgeon confirms the expected length of the surgery and the number of days of hospitalization depending on the surgery and healing period post-surgery.

Complication of leaving an Intestinal Fistula untreated

Depending on the type, the complications of an untreated intestinal fistula may lead to obstruction of the bowels and incontinence, dehydration, low blood pressure, and reoccurrence of the fistula at some other location. 

As the severity increases, it may lead to sepsis (the most common), damage the other organs involved, and ultimately cause death if left untreated.