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 feces 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 for spongy fistulas.
More about the disease
Intestinal fistula is a pathology that progresses intensively due to an increase in the number of inflammatory processes in the intestine. The latter most often entail the formation of unnaturalcommunications. This disease can have a congenital, acquired and artificial form. The first surgical intervention for a fistula in the intestine was carried out in the 18th century. In modern medicine, different methods of surgical treatment of such a pathology are used.
Reasons
The main reasons for the appearance of a 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 due to impaired blood flow and nutrition of intestinal tissues. Intestinal fistulas can also result from penetrating and blunt abdominal trauma.
The most basic reasons for the maturation of the fistula include complications that appeared after surgery. An infrequent cause of the appearance of such a pathology are violations of embryonic growth. Fistulous passages that appear between the intestines and other organs entail serious disorders in the body. The pathogenetic mechanism of the development of multiple organ failure syndrome (MOS) is related to the loss of the contents of the stomach or intestines, problems associated with the absorption of nutrients, intoxication, which appears due to inflammation in the area of the fistula.
Fistulas of the small intestine are considered the most dangerous, because up to 10 liters of fluid can leak through them per day, which leads to dehydration of the body and loss of digestive juices and enzymes. Dehydration leads to lossblood that passes through the channels of the kidneys. The production of aldosterone increases, as a result of which potassium is actively washed out. In addition, the process of absorption of biologically significant elements in the intestine is disrupted.
At first, the body's energy resources are covered by breaking down glycogen stores in the liver and muscles, after which catabolism processes are launched, which involve the consumption of protein and fat reserves. Against the background of excessive dissimilation, cell breakdown is observed, which leads to the accumulation of potassium, toxic waste products of metabolism. As a result of such phenomena, the kidneys are subjected to a special load. There is a development of exhaustion and PON, which in 40% leads to death.
Fistula in the large intestine and the one that is formed in the thin section, do not often entail obvious dystrophic disorders. 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 parts of the 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 mucosa of the discharge section of the intestine suffers.
Types of intestinal fistulas
Intestinal fistulas are divided into congenital and acquired. The first option is extremely rare. As a rule, such a pathology is caused by insufficient development of the intestinal tube or a cleft of the intestinal cystic duct. As for the acquired form, thenalmost half of all cases that are known to medical practice are associated with complications that appeared after the operation. Acquired species also include fistulas, which are created artificially. Such holes are made for the purpose of enteral nutrition, unloading the organ during peritonitis, tumor formations, intestinal obstruction.
By the type of connection, intestinal fistulas are divided into:
- outer;
- domestic;
- mixed.
Internal fistulas communicate the intestinal cavity with organs such as the uterus, bladder. They can also join other sections of the intestine. The external type is characterized by an opening on the surface of the skin. 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 into the wound of the abdominal wall or a purulent cavity, as well as those that are devoid of a fistulous passage due to the fact that they are attached to the intestinal mucosa and to the skin.
For holes of the formed type, the presence of a fistulous tract is characteristic, which is lined with tissue covering the surface of the body cavity. Such a fistula plan may have different moves that differ in length, width and shape. Fistulas are also single and multiple. Depending on the content, they are divided into complete 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 orfalse. As for incomplete fistulas, with such a pathology, the contents of the organ do not come out completely.
Symptoms
Symptoms of intestinal fistula depend on their location, characteristics, period of occurrence. The course of the disease with fistulas of the formed type is considered easier. This species is not characterized by the presence of severe symptoms. With unformed fistulas, intoxication is observed, which is caused by inflammation in the region of the mouth of the fistulous passage.
Photo fistula of the intestine can be easily found in specialized medical literature. With such a pathology, you must definitely contact the doctors.
If we talk about internal inter-intestinal fistulas, they may not make themselves felt for a long period. Against the background of intestinal-uterine and intestinal-bubbly fistulas, leakage of feces through the vagina is observed, it is also found in the urine at the time of emptying the bladder. With a fistula in the large intestine, the following symptoms are observed:
- severe diarrhea;
- significant weight loss.
For external fistulas, some clinical features are characteristic, which depend on their location. With high enteric fistulas, a defect appears on the skin, through which there is an outflow of yellow intestinal contents, including juices of the digestive tract, bile, food chyme. Dermatitis often develops around the cavity. 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 50% weight, over timehe will develop serious exhaustion, depression.
As for low fistulas that develop in the large intestine, they are not characterized by loss of fluid in a large volume. If we take into account the fact that the feces in this area have already been formed, then the conclusion follows that the violation of the integrity of the epidermis and dermatitis will not develop. Common complications of intestinal fistulas include fluid and electrolyte imbalance, bleeding, exhaustion, etc.
Diagnosis
If such a pathology is suspected, a visit to a gastroenterologist and a 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 a fistulous tract, determine its shape. In the future, the patient will be assigned other diagnostic measures. To find out where the pathological hole is located, fluid from the fistulous tract is taken as a material for analysis. This is done in order to identify bilirubin, bile acids, enzymes produced by the pancreas in it.
In addition, tests with dyes are carried out. If there is a suspicion of a fistula of the small intestine, the patient ingests methylene blue. If a fistula is found in the large intestine, the agent is administered by means of an enema. Depending on the period of occurrence of the dye in the liquid released from the hole, the exact location of its location is determined. To find out what condition the internal organs are in and whether they are related tofistulous canal, the patient is prescribed 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, find out if the intestinal mucosa has been damaged and whether there is a true or false spur.
Treatment
Treatment of fistulas in the intestine is carried out in a hospital setting. If high enteric fistulas were detected, the patient is placed in intensive care or in the department of surgery. Patients who have asymptomatic colonic fistulas are referred to gastroenterology or prescribed home therapy. At the initial stage of treatment, conservative manipulations are carried out, which involve replenishing 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 tract, the patient is given eradication of the infection area and detoxification procedures. Local therapy is based on the use of dressings soaked in a hypertonic or enzyme solution. Ointments and pastes with an antiseptic effect are applied to the pathological areas. The skin is also protected from the fluid separated from the intestines. The principle of physical protection is to create a barrier between the skin and organ secretions. For this purpose, paste, BF 1, BF 2 glue, polymer films are used.
Protection in a biochemical way iswrapping the mouth of the fistulous passage with napkins soaked in milk, lactic acid or raw egg white. To carry out a mechanical blockade, devices are used in the form of an aspirator and an obturator, which prevents the intestinal contents from escaping to the outside. To neutralize pancreatic and gastric juice, blockers of histamine receptors, proteases may be involved.
At the time of conservative therapy, it is extremely important to adhere to certain nutritional rules. With the help of conservative treatment methods, the formed fistula is tightened 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 used for 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 a large volume.
The surgical method of removing labial intestinal fistulas is resorted to in cases where they do not drag on for a long period. For fistulas that are incomplete tubular or lip-shaped, extraperitoneal methods of closing them are appropriate. To eliminate all other types of fistulas, the laparotomy method is prescribed.
If labial fistulas of the large intestine have been diagnosed, an operation may be prescribed, the method of which depends on the type of fistula (complete or incomplete). With incomplete labial fistulas, which havesmall size, resort to extra-abdominal options for their closure. This method involves isolating the intestinal wall in the area of the fistula and stitching the hole with a double-row suture.
With large incomplete and complete fistulas of the labial type, the use of intra-abdominal methods of removal is prescribed. To do this, the intestine is isolated along the entire perimeter of the pathological opening, it is brought out into the wound and the fistula is sutured if it is incomplete. With a complete fistula, an anastomosis is performed. If fistulas were found in large numbers, which are located on one intestinal loop, it is resected and anastomosis is applied.
Folk remedies
If a fistula of the small intestine was found, a folk remedy can be included in a comprehensive treatment regimen. They have a therapeutic effect and help eliminate inflammation. For fistulas of the rectum, you can use one of the following recipes:
- Combine vodka and olive oil in equal proportions. Wipe the composition of the sore spot several times a day. After the procedure, apply a cabbage leaf to the fistula.
- Mix 1:1 mummy and aloe leaf juice. Soak a bandage in the liquid and apply the bandage to the affected area.
- Place in a container of 2 tbsp. l. dry St. John's wort, pour 400 ml of water. Bring the composition to a boil. Cool the resulting broth, then strain. Apply a bandage soaked in herbal infusion to the fistula area.
- Take equal proportions of oak bark, water pepper grass, flax flowers, pour raw materials with melted lard and heat. ATmoisten a cotton swab and apply to the site with a fistula.
Forecast and prevention
Lethal outcome after surgery for 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, it is possible to influence its spontaneous tightening. As for preventive measures, they consist in the timely diagnosis and treatment of underlying diseases that entail the formation of fistulous tracts.
Conclusion
It is easier to get rid of a fistula in the early stages of its appearance. It is extremely dangerous to treat a fistula of the small intestine on your 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 in time.
