What is a fistula? Symptoms and treatment
Fistula is a canal that connects the body cavity or hollow organs with the external environment or with each other. Still fistula called fistula. Most often, it presents a narrow canalized, which is internally covered with epithelium or of new connective tissue.
Fistulas can develop on the background of the various pathological processes occurring in the body, and after undergoing surgery.
The content of the article:
Types of fistulasThere are types of fistulas depending on their location in the body:
Rectal fistula. He, in turn, is divided into a rectal (anus or rectum to the skin), and perianal (out of the anal crypts to the skin).
Recto vaginal fistula, recto vaginal any damage to the wall.
Duodenal fistula, which affects the duodenum.
Bronchial fistula, which connects the lumen of the bronchi pleura, etc.
- Depending on the origin of the fistula, it can be acquired or congenital. Congenital fistulas are formed during fetal development, the presence of any defects. More often found median and lateral neck fistula, and fistula of the umbilicus. Acquired fistulas are formed on the background of any pathological process, they can also be the result of injury or surgery.
- Sometimes the doctors themselves form a fistula to improve the functioning of the authority, if it is not possible to remove it. For example, to the outflow of urine, to the internal passage of the stomach contents, etc. Are called artificial fistula (stoma).
- Depending on whether, or not he confers with the external environment, fistulas are external or internal.
External fistulas connect the organs, or pathological foci of infection of the tissues (bones) located in the human body with the external environment. They tend to occur in various infectious diseases (perianal, urinary, intestinal, osteomyelities fistula).
Internal fistulas connect the bodies with each other or with another cavity. So,distinguish gastro-intestinal, bronchial-pleural, or other types of fistulas. They are formed by the decay tissues on the background of pathological processes. When nearby organs are glued and spliced with each other, their interstices are interconnected.
- Depending on the structure fistulas are granulating, epitelizirutmi and golovine.
- Depending on what content is separated from the channel are fistula salivary, urinary, purulent, mucous, Licorne, feces, mucous, etc.
The structure of the fistulaExternal fistulas always have two mouth: outer and inner, which are connected to each other by the channel. Sometimes the canal may be absent. In this case, the body wall adjacent to the skin, or even acts on it.
Granulating fistula is covered with granulation tissue. They are pathological, as are formed on the background of inflammatory processes. The mechanism of their development is as follows:
- Limited to an inflammatory lesion from the surrounding tissue, and then breaks out.
- A major breakthrough formed the channel through which comes the pathological contents.
- Over time, the channel is covered with granulation tissue, and around it is formed of connective scar tissue. The walls of the fistula become fixed and sealed.
Heal this fistula does not the fact that it constantly runs any discharge. If it has a reactive formula, it will destroy the granulation and facilitate the penetration of toxins and microbes in the surrounding tissues. In the end, around the fistula scars are formed. In addition, suppuration of the fistula risk that abscesses and new cellulitis can form other fistulas, opened in nearby tissues. If pathological content no longer pass through the channel of the fistula, he can self-heal.
Epitelizirutmi fistula is the fistula of the duct wall which is covered with epithelium. When the epithelium of the mucous membrane of the internal organ and passes to the skin, these fistulas are called Goloviznina. Is the name of the fistula got for the reason that the wall bulges above the skin and looks like a lip person. Most of these fistulas form an artificial way. Independently epitelizirutmi fistulas heal not can.
As for the discharge that emerges from the cavity of the fistula, it depends on what authority it is related.The more aggressive the exudate, the more damaged the skin around the fistula. For example, if intestinal fistula and the skin is being eroded and is covered with sores.
Fistulas are dangerous because they can lead to disorders in the body. In addition, they are formed on the background of inflammatory process, and thus, their development is accompanied by intoxication and loss of fluid. All the same intestinal fistula cause a flow of digestive fluids. In the future, it leads to a violation of water-salt balance and metabolic failures.
If the pathological changes in the body is very pronounced, there is a risk of death of the patient.
The symptoms of fistulaThe clinical picture that characterizes the presence of a fistula depends on what exactly was the reason for its formation and where it is located.
On the outside of the fistula indicates the presence of holes on the skin, from which the liquid is released. To precede the appearance of this hole can trauma to this area, inflammation of adjacent tissues and organs, and surgery.
From what content stands out from the mouth of the fistula will depend on the condition of the skin next to it. Near gastric and duodenal they hiss most often there is dermatitis, as the skin is corroded by digestive juices. Next to urinary fistulas dermis edematous, and further is formed elephantiasis.
As for the General reaction of the organism, it can vary considerably. Degradation will occur in the case when the fistula penetrates the pathogen and develops secondary infection. Severe disease is typical of a purulent fistula.
Internal fistulas are often the result of complications of diseases chronic or acute course. For example, to the formation of a biliary fistula may result in obstruction of the biliary ducts by calculi. In this case, the symptoms will depend on how much of bile daily secreted into the peritoneal cavity. A person can suffer from severe pain in the abdomen, from disruptions in the digestive process.
If a person bronchopneumania fistula, they may indicate chronic aspiration pneumonia or bronchitis, which occur against the backdrop of falling into the tracheobronchial tree pieces of food.
If we consider a direct fistula of the intestine, their presence will indicate the following symptoms:
- In the anus there will be a hole. It often remains barely noticeable. From this hole will always be fluid, possibly with pus. For this reasonthe person will have to wear a pad.
- In the anus will always be painful. During bowel movement they increase.
If the patient has a fistula has formed on the gums, the clinical picture is as follows:
- Teeth acquire abnormal mobility;
- Teeth hurt during the touch;
Sometimes the background to the development of inflammation increases body temperature;
- Available on the gums fistula pus.
The causes of fistulaThere are two main reasons for the formation of fistulas:
Of pathological fistula. They are formed independently due to different inflammatory processes in the body.
The factors that can influence the formation of pathological fistula:
The injury, which damaged the shell of the organ or vessel;
Destructive processes of chronic: sclerosis of the tissues, loss of elasticity, softening of the fibers, the presence of erosions and ulcerations;
The inflammatory response in the body in which the fistula formation is just a defensive reaction.
Surgical fistula. These channels are formed by the surgeon. An example of such a fistula is gastrostomy when the stomach communicates with the external environment by means of the hole. Sometimes surgical fistula leave on a permanent basis, to provide communication between the internal organs themselves.
Diagnosis of fistulasDiagnosis of the fistula usually is not difficult. His hole is visible to the naked eye. If the mouth stands out from the fistula of the pathological content, the patient exhibited diagnosis. However, this does not mean that the survey is completed. It will continue to establish the exact cause of its formation. Only in this case will be able to prescribe the most effective treatment.
The simplest method of diagnosis is sensing. Fistulous course explore with a probe. This allows you to determine its depthand the direction where it leads. To find out whether the fistula with a hollow body, the patient is injected the dye. If it stands out from the orifice of the fistula back, the body is not hollow.
It is also possible to conduct fistulography. During the study procedure, the fistula is filled with the radiopaque substance, and perform a series of shots.
Fibrogastroscopy, bronchoscopy, cystoscopy and other x-ray examinations carried out, depending on how it is reported on fistula.
On the background of inflammation, accompanied by swelling of the tissues, the fistula may not be noticeable. For this reason, the diagnosis is sometimes delayed in time. This complicates the subsequent treatment.
Treatment of fistulasConservative treatment can only granulomatous fistula, as they are able to grow at elimination of pathological causes of the caller.
It is very important to prevent the development of infection for which the patient is prescribed antibiotics such as topically in the form of injections (to reduce pain use novocaine) and systemically.
The skin around the fistula accurately treated and put on her sterile bandages with vaseline or paste lassara. At the same time being symptomatic and restorative therapy. Shown high-calorie nutrition, vitamin injections, fluids, etc.
The operation is prescribed for epitelizirutmi fistula because they can't grow themselves. Also surgical intervention is carried out at a granulating fistula, which is a long time to heal.
Features of surgical treatment of different types of fistulas:
Epitelizirutmi fistula. The most important point during surgery is not only the elimination of the pathological focus, and removal of the epithelial cover of the fistula.
Goloviznin fistula. Body from which the fistula is separated from all surrounding tissue, the diameter of the mouth. The existing hole is sewn up so that it is turned inside the hollow body. If cicatricial changes very pronounced, you may need to remove the entire organ.
Granulating fistula. During surgery is necessary to remove all necrotic tissue, foreign body, sequestrum, etc. is Important ensuring the quality of the outflow from the wound, but in any case not through the channel of the fistula.
After the operation the patient is prescribed an antibacterial treatment, conduct detoxication therapy. Perhaps the appointment physiotherapy, for example, UHF orUV irradiation.
It should be remembered that one of the most important factors that enable you to achieve success in the treatment of fistula is a quality care for them. In addition to impeccable handling and toilet skin it is necessary to use a protective paste, which will not allow to prevent infection.