A gastrointestinal fistula is a severe medical condition that may require long-term care. This article will describe the most common causes, treatments, and complications of gastrointestinal fistulae.
Causes
Around 85–90 percent of all gastrointestinal fistulae occur as a complication of surgical procedures.
In a study of 1,148 people undergoing abdominal surgery, researchers noted that 5.5 percent of participants developed fistulae after their operation. Most fistulae appeared during the first week after surgery.
A doctor should always discuss the risks of fistulae with a person before they have abdominal surgery. They should also check in with the individual after the surgery in case they have any symptoms of a fistula, as a prompt diagnosis is likely to improve the outcome.
Other possible causes of gastrointestinal fistulae include:
- a history of radiation to the abdomen
- infection, such as diverticulitis
- inflammatory bowel diseases, including Crohn’s disease
- an ulcer in the gut
- physical injury to the abdomen
- cancer
A doctor will consider a person’s medical history when diagnosing a gastrointestinal fistula. If a person has had specific surgical procedures, including gynecologic surgery, they have a higher risk of getting a fistula.
The doctor will also ask about the person’s symptoms, including when they presented and whether anything relieves or worsens them.
If the doctor suspects a gastrointestinal fistula, they will order medical tests to confirm the diagnosis. These tests may include:
- Imaging scans, such as a CT scan, to identify the fistula and determine its size. This is essential so that surgeons can decide where to place drains and operate.
- Barium studies, in which the doctor will administer barium to the individual orally or by enema before taking an X-ray. If the barium reveals signs of leaking in the intestines, this will confirm the fistula’s presence.
- Fistulogram, a diagnostic test that involves injecting dye into the area of the gastrointestinal fistula where the skin is open and leaking. This should reveal any blockages in the fistula.
The presence of food in the gut triggers the additional secretion of gastric juices, preventing a person with a fistula from getting enough nutrients.
A lack of nutrition will make it difficult for a person’s body to heal. Therefore, alongside surgical treatment, a doctor will often recommend alternative forms of nutrition while the gut heals.
For example, they may recommend total parenteral nutrition (TPN), which involves administering nutrients via a central intravenous (IV) line.
A doctor may also prescribe medications to reduce stomach fluid and saliva. This will reduce the amount of fluid in the gut. Examples include:
- glycopyrrolate or scopolamine to decrease saliva production
- proton-pump inhibitors, such as omeprazole (Prilosec), which reduce acid secretions
- H2-receptor antagonists, such as famotidine (Pepcid) or ranitidine (Zantac), which also reduce stomach acid
- anti-diarrheal drugs, such as loperamide or codeine phosphate
A doctor will sometimes give medications that are chemically similar to the hormone somatostatin, such as octreotide and lanreotide. This hormone can significantly reduce gastrointestinal secretions, which can help the fistula to heal.
While this therapy is not right for everyone, it can help some people reduce their symptoms without experiencing as many side effects.
Complications
A gastrointestinal fistula can lead to various complications, which include:
- infection
- malnutrition
- electrolyte imbalances
- poor wound healing
Around 25 percent of fistulae will heal within 30–40 days with correct nutrition and some medical management. However, the mortality rate for all gastrointestinal fistulae can be as high as 40 percent. As such, it is important for people to seek immediate treatment for this condition.
Outlook
A gastrointestinal fistula can be a severe condition that may spontaneously resolve but can sometimes require treatment.
When a fistula does occur, it can take a significant amount of time to get better. However, with medications and nutrition management, most people will be able to heal the affected area.
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