Gastrointestinal fistulation

A gastrointestinal fistula (plural: fistulae or fistulas) is an abnormal connection or fistula, between the gut and another epithelial-/endothelial-lined surface, such as another organ system, the skin surface, or elsewhere along the gastrointestinal tract. Some authors exclude fistulas involving the large bowel and oesophagus when classifying or describing gastrointestinal fistulas.

Terminology

The formation of a fistula may be referred to as fistulation or fistulisation, both terms are equally valid ⁸.

Pathology

Gastrointestinal fistulas can be congenital or acquired in nature. They are generally named according to their participating anatomic components, and virtually every imaginable combination has been reported. Examples include

• gut - gut:

  • enteroenteric fistula

  • coloenteric fistula

  • coloduodenal fistula

  • gastrocolic fistula

• gut - skin:

  • enterocutaneous fistula

  • gastrocutaneous fistula

  • colocutaneous fistula

  • certain perianal fistulas

• gut - bladder:

  • enterovesical fistula

  • colovesical fistula / rectovesical fistula

• gut - ureter: 

  • ureterocolic fistula

  • ureteroduodenal fistula

  • ureteroenteric fistula

• gut - kidney:

  • renocolic fistula

  • renoenteric fistula

• gut - spleen:

  • gastrosplenic fistula

• gut - vagina:

  • enterovaginal fistula

  • colovaginal fistula

  • anovaginal fistula

  • rectovaginal fistula: commonest GI fistula involving the female genital tract ²

• gut - biliary tract:

  • cholecystoduodenal fistula: commonest to involve the biliary tract ²

  • cholecystocolonic fistula

  • choledochoduodenal fistula

  • choledochocolonic fistula

• gut - pancreas

  • enteropancreatic fistula

  • gastropancreatic fistula

• gut - vascular system:

  • aortoenteric fistula

  • aortoduodenal fistula

Aetiology

Their causes can be as diverse as their types and include ²

• acquired:

  • common:

    • post-surgical: considered most common cause ³

    • Crohn disease

    • diverticulitis

  • less common:

    • due to abdominal malignancies: colon cancer

    • radiotherapy

    • due to foreign bodies

    • intra-abdominal trauma ⁴

    • atypical intra-abdominal infections:

      • tuberculosis

      • histoplasmosis

      • actinomycosis

      • xanthogranulomatous pyelonephritis

      • amoebiasis

      • echinococcosis

      • lymphogranuloma venereum

    • cholecystitis

    • pancreatitis

    • appendicitis

• congenital:

  • congenital dorsal-enteric fistula: associated with split notochord syndrome ⁷

  • congenital enteroenteric: associated with an omphalocele

History and etymology

Fistula is the Latin word for pipe ⁹.