Fistula Classification and external resources
MeSH	D005402

In medicine, a fistula (pl. Medical Subject Headings ( MeSH) is a huge Controlled vocabulary (or metadata system for the purpose of indexing journal articles and books fistulas or fistulae) is an abnormal connection or passageway between two epithelium-lined organs or vessels that normally do not connect. In biology and medicine epithelium is a tissue composed of cells that line the cavities and surfaces of structures throughout the body

Contents 1 Location of fistulas 1.1 H: Diseases of the eye, adnexa, ear, and mastoid process 1.2 I: Diseases of the circulatory system 1.3 J: Diseases of the respiratory system 1.4 K: Diseases of the digestive system 1.5 M: Diseases of the musculoskeletal system and connective tissue 1.6 N: Diseases of the genitourinary system 1.7 Q: Congenital malformations, deformations and chromosomal abnormalities 1.8 T: External causes 2 Types of fistulas 3 Causes 4 Treatment 5 Therapeutic use 6 See also 7 References 8 External links

Location of fistulas

Fistulas can develop in various parts of the body. The following list is sorted by the International Statistical Classification of Diseases and Related Health Problems. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases

H: Diseases of the eye, adnexa, ear, and mastoid process

• (H04. 6) Lacrimal fistula
• (H70. 1) Mastoid fistula
  • Craniosinus fistula: between the intracranial space and a paranasal sinus
• (H83. The cranial cavity, or intracranial space, is the space formed inside the Skull. Paranasal sinuses are air-filled spaces communicating with the nasal cavity within the bones of the Skull and face 1) Labyrinthine fistula
  • Perilymph fistula: tear between the membranes between the middle and inner ears

I: Diseases of the circulatory system

• (I25. A labyrinthine fistula (or perilymph fistula) is leakage of Inner ear fluid into the air filled Middle ear. The ear is the sense organ that detects Sounds The Vertebrate ear shows a common biology from Fish to Humans with variations 4) Coronary arteriovenous fistula, acquired
• (I28. 0) Arteriovenous fistula of pulmonary vessels
  • Pulmonary arteriovenous fistula: between an artery and vein of the lungs, resulting in shunting of blood. An arteriovenous fistula is an abnormal connection or passageway between an Artery and a Vein. Pulmonary circulation is the portion of the Cardiovascular system which carries Oxygen -depleted Blood away from the heart to the Lungs, and lung is the essential Respiration organ in air-breathing Animals including most Tetrapods a few Fish and a few Snails The most primitive Shunting is an event in the Neuron which occurs when an Excitatory postsynaptic potential and an Inhibitory postsynaptic potential are occurring close to Blood is a specialized Bodily fluid that delivers necessary substances to the body's cells ��such as nutrients and oxygen—and transports Waste products This results in improperly oxygenated blood.
• (I67. 1) Cerebral arteriovenous fistula, acquired
• (I77. An arteriovenous fistula is an abnormal connection or passageway between an Artery and a Vein. 0) Arteriovenous fistula, acquired
• (I77. An arteriovenous fistula is an abnormal connection or passageway between an Artery and a Vein. 2) Fistula of artery

J: Diseases of the respiratory system

• (J86. Arteries are Blood vessels that carry blood away from the Heart. 0) Pyothorax with fistula
• (J95. An empyema is a collection of Pus within a naturally existing anatomical cavity 0) Tracheoesophageal fistula following tracheostomy: between the breathing and the feeding tubes

K: Diseases of the digestive system

• (K11. A tracheoesophageal fistula (TEF is an abnormal connection ( Fistula) between the Esophagus and the trachea. Tracheotomy and tracheostomy are Surgical procedures on the neck to open a direct airway through an incision in the trachea (the windpipe 4) Fistula of salivary gland
• (K31. The salivary glands in mammals are exocrine glands that produce saliva 6) Fistula of stomach and duodenum
• (K31. In Human anatomy, the stomach is a J-shaped hollow muscular organ of the Gastrointestinal tract involved in the second phase of Digestion, following In Anatomy of the Digestive system, the duodenum is a hollow jointed tube about 25-30 cm (10-12 in long connecting the Stomach to the Jejunum 6) Gastrocolic fistula
• (K31. 6) Gastrojejunocolic fistula
  • Enterocutaneous fistula: between the intestine and the skin surface, namely from the duodenum or the jejunum or the ileum. In Anatomy of the Digestive system, the duodenum is a hollow jointed tube about 25-30 cm (10-12 in long connecting the Stomach to the Jejunum In Anatomy of the Digestive system, the jejunum is the central of the three divisions of the Small intestine and lies between the Duodenum and In Anatomy of the Digestive system, the ileum is the final section of the Small intestine. This definition excludes the fistulas arising from the colon or the appendix. The colon is a storage tube for solid wastes The main function of the colon appears to be extraction of Water and salts from Feces.
  • Gastric fistula: from the stomach to the skin surface
• (K38. In Human anatomy, the stomach is a J-shaped hollow muscular organ of the Gastrointestinal tract involved in the second phase of Digestion, following 3) Fistula of appendix
• (K60.3) Anal fistula
  • (K60.3) Anorectal fistula: connecting the rectum or other anorectal area to the skin surface. K00-K93 - Diseases of the digestive system (K00-K14 Diseases of oral cavity salivary glands and jaws ( Disorders of Tooth development and Eruption An Anal Fistula is an abnormal connection between the Epithelialised surface of the Anal canal and (usually the Perianal skin K00-K93 - Diseases of the digestive system (K00-K14 Diseases of oral cavity salivary glands and jaws ( Disorders of Tooth development and Eruption An Anal Fistula is an abnormal connection between the Epithelialised surface of the Anal canal and (usually the Perianal skin The rectum (from the Latin rectum intestinum, meaning straight intestine) is the final straight portion of the Large intestine in some Mammals Anorectal anomalies are Medical problems affecting the structure of the Anus and Rectum. The skin is the outer covering of living tissue of an animal (or plant This results in abnormal discharge of feces through an opening other than the anus. Feces, faeces, or fæces (see spelling differences) is a waste product from an animal's digestive tract expelled through the Anus The anus is an opening at the opposite end of an Animal 's Digestive tract from the Mouth. Also called fistula-in-ano.
    • Fecal fistula: see Anorectal
    • Fistula-in-ano: see Anorectal
• (K60.4) Rectal fistula
• (K60.5) Anorectal fistula
• (K63. K00-K93 - Diseases of the digestive system (K00-K14 Diseases of oral cavity salivary glands and jaws ( Disorders of Tooth development and Eruption An Anal Fistula is an abnormal connection between the Epithelialised surface of the Anal canal and (usually the Perianal skin K00-K93 - Diseases of the digestive system (K00-K14 Diseases of oral cavity salivary glands and jaws ( Disorders of Tooth development and Eruption An Anal Fistula is an abnormal connection between the Epithelialised surface of the Anal canal and (usually the Perianal skin 2) Fistula of intestine
  • Enteroenteral fistula: between two parts of the intestine
• (K82. In Anatomy, the intestine is the segment of the alimentary canal extending from the Stomach to the Anus and in humans and other mammals consists In Anatomy, the intestine is the segment of the alimentary canal extending from the Stomach to the Anus and in humans and other mammals consists 3) Fistula of gallbladder
• (K83. The gallbladder (or cholecyst sometimes gall bladder is a small organ whose function in the body is to store Bile and aid in the digestive process 3) Fistula of bile duct
  • Biliary fistula: connecting the bile ducts to the skin surface, often caused by gallbladder surgery
  • Pancreatic fistula: between the pancreas and the exterior via the abdominal wall

M: Diseases of the musculoskeletal system and connective tissue

• (M25. A bile duct is any of a number of long tube-like structures that carry Bile. A biliary fistula, a type of Fistula where Bile leaks from the Bile ducts into outside areas can occur as a complication following biliary trauma Bile or gall is a bitter yellow or green Alkaline fluid secreted by Hepatocytes from the Liver of most Vertebrates In many species The gallbladder (or cholecyst sometimes gall bladder is a small organ whose function in the body is to store Bile and aid in the digestive process A pancreatic fistula is an abnormal communication between the Pancreas and other organs due to leakage of pancreatic secretions from damaged pancreatic ducts The pancreas is a Gland organ in the digestive and Endocrine system of Vertebrates. The abdominal wall represents the boundaries of the Abdominal cavity. 1) Fistula of joint

N: Diseases of the genitourinary system

• (N32. A joint is the location at which two or more Bones make contact 1) Vesicointestinal fistula
• (N36. A vesicointestinal fistula (or intestinovesical fistula) is a form of Fistula between the bladder and the Bowel. 0) Urethral fistula
  • Innora:between the prostatic utricle and the outside of the body
• (N64. The prostatic utricle (Latin for "pouch of the Prostate " is a small indentation located in the Prostatic urethra, at the apex of the Urethral crest 0) Fistula of nipple
• (N82) Fistulae involving female genital tract / Obstetric fistula
  • (N82. Obstetric fistula (or vaginal fistula) is a severe medical condition in which a Fistula (hole develops between either the Rectum and Vagina 0) Vesicovaginal fistula: between the bladder and the vagina
  • (N82. Vesicovaginal fistula (VVF is a subtype of female urogenital Fistula (UGF In Anatomy, the urinary bladder is a hollow muscular, and distensible (or elastic organ that sits on the Pelvic floor in Mammals It is the The vagina (from Latin, literally " Sheath " or " Scabbard " is a fibromuscular tubular tract leading from the Uterus 1) Other female urinary-genital tract fistulae
    • Cervical fistula: abnormal opening in the cervix
  • (N82. The cervix (from Latin "neck" is the lower narrow portion of the Uterus where it joins with the top end of the Vagina. 2) Fistula of vagina to small intestine
    • Enterovaginal fistula: between the intestine and the vagina
  • (N82. In Anatomy, the intestine is the segment of the alimentary canal extending from the Stomach to the Anus and in humans and other mammals consists The vagina (from Latin, literally " Sheath " or " Scabbard " is a fibromuscular tubular tract leading from the Uterus 3) Fistula of vagina to large intestine
    • Rectovaginal: between the rectum and the vagina
  • (N82. A rectovaginal fistula is a medical condition where there is a Fistula or abnormal connection between the Rectum and the Vagina. A rectovaginal fistula is a medical condition where there is a Fistula or abnormal connection between the Rectum and the Vagina. The rectum (from the Latin rectum intestinum, meaning straight intestine) is the final straight portion of the Large intestine in some Mammals The vagina (from Latin, literally " Sheath " or " Scabbard " is a fibromuscular tubular tract leading from the Uterus 4) Other female intestinal-genital tract fistulae
  • (N82. 5) Female genital tract-skin fistulae
  • (N82. 8) Other female genital tract fistulae
  • (N82. 9) Female genital tract fistula, unspecified

Q: Congenital malformations, deformations and chromosomal abnormalities

• (Q18. 0) Sinus, fistula and cyst of branchial cleft
  • Congenital Preauricular fistula: A small pit in front of the ear. Sinus is Latin for "bay" "pocket" "curve" or "bosom" A cyst is a closed sac having a distinct membrane and Division on the nearby tissue. In the development of vertebrate animals, the pharyngeal arches (also called branchial arches or gill arches in fish develop during the fourth A congenital disorder is a disease or disorder that is present at birth The ear is the sense organ that detects Sounds The Vertebrate ear shows a common biology from Fish to Humans with variations Also called Fistula Auris Congenita or Ear Pit.
• (Q26. 6) Portal vein-hepatic artery fistula
• (Q38. 0) Congenital fistula of lip
• (Q38. A congenital disorder is a disease or disorder that is present at birth Lips are a visible body part at the mouth of humans and many animals 4) Congenital fistula of salivary gland
• (Q42. A congenital disorder is a disease or disorder that is present at birth The salivary glands in mammals are exocrine glands that produce saliva 0) Congenital absence, atresia and stenosis of rectum with fistula
• (Q42. A congenital disorder is a disease or disorder that is present at birth Absenteeism is a habitual pattern of absence from a duty or obligation Atresia is a condition in which a body Orifice or passage in the body is abnormally closed or absent A stenosis ( Plural: stenoses; from Ancient Greek στένωσις "narrowing" is an abnormal narrowing in a Blood vessel The rectum (from the Latin rectum intestinum, meaning straight intestine) is the final straight portion of the Large intestine in some Mammals 2) Congenital absence, atresia and stenosis of anus with fistula
• (Q43. A congenital disorder is a disease or disorder that is present at birth Absenteeism is a habitual pattern of absence from a duty or obligation Atresia is a condition in which a body Orifice or passage in the body is abnormally closed or absent A stenosis ( Plural: stenoses; from Ancient Greek στένωσις "narrowing" is an abnormal narrowing in a Blood vessel The anus is an opening at the opposite end of an Animal 's Digestive tract from the Mouth. 6) Congenital fistula of rectum and anus
• (Q51. A congenital disorder is a disease or disorder that is present at birth The rectum (from the Latin rectum intestinum, meaning straight intestine) is the final straight portion of the Large intestine in some Mammals The anus is an opening at the opposite end of an Animal 's Digestive tract from the Mouth. 7) Congenital fistulae between uterus and digestive and urinary tracts
• (Q52. A congenital disorder is a disease or disorder that is present at birth The uterus (from the Latin word for womb) is the major Female reproductive organ of most Mammals including Humans One end the 2) Congenital rectovaginal fistula

T: External causes

• (T14. A congenital disorder is a disease or disorder that is present at birth A rectovaginal fistula is a medical condition where there is a Fistula or abnormal connection between the Rectum and the Vagina. 5) Traumatic arteriovenous fistula
• (T81. 8) Persistent postoperative fistula

Types of fistulas

Various types of fistulas include:

• Blind: with only one open end
• Complete: with both external and internal openings
• Incomplete: a fistula with an external skin opening, which does not connect to any internal organ

Although most fistulas are in forms of a tube, some can also have multiple branches.

Causes

Various causes of fistula are:

• Diseases: Inflammatory bowel diseases, such as Crohn's disease and ulcerative colitis, are the leading causes of anorectal, enteroenteral, and enterocutaneous fistulas. Crohn's disease is a Disease of the Digestive system which may affect any part of the Gastrointestinal tract from Mouth to Anus Ulcerative colitis ( Colitis ulcerosa, UC) is a form of Inflammatory bowel disease (IBD A person with severe stage-3 hidradenitis suppurativa will also develop fistulas. Hidradenitis suppurativa or HS is a Skin disease that affects areas bearing Apocrine sweat glands and Hair follicles such as the underarms groin

• Medical treatment: Complications from gallbladder surgery can lead to biliary fistula. Radiation therapy can lead to vesicovaginal fistula. An arteriovenous fistula can be deliberately created, as described below in therapeutic use.

• Trauma: Head trauma can lead to perilymph fistulas, whereas trauma to other parts of the body can cause arteriovenous fistulas. A labyrinthine fistula (or perilymph fistula) is leakage of Inner ear fluid into the air filled Middle ear. Obstructed labor can lead to vesicovaginal and rectovaginal fistulas. An obstetric fistula develops when blood supply to the tissues of the vagina and the bladder (and/or rectum) is cut off during prolonged obstructed labor. Obstetric fistula (or vaginal fistula) is a severe medical condition in which a Fistula (hole develops between either the Rectum and Vagina The tissues die and a hole forms through which urine and/or feces pass uncontrollably. Vesicovaginal and rectovaginal fistulas may also be caused by rape, in particular gang rape, and rape with foreign objects, as evidenced by the abnormally high number of women in conflict areas who have suffered fistulae. ^[1][2]

• In 2003, thousands of women in eastern Congo presented themselves for treatment of traumatic fistula caused by systematic, violent gang rape that occurred during the country's five years of war. So many cases have been reported that the destruction of the vagina is considered a war injury and recorded by doctors as a crime of combat. ^[3]

Treatment

Treatment for fistulae varies depending on the cause and extent of the fistula, but often involves surgical intervention combined with antibiotic therapy. In modern usage an antibiotic is a Chemotherapeutic agent with activity against Microorganisms such as Bacteria, fungi or Protozoa

Typically the first step in treating a fistula is an examination by a doctor to determine the extent and "path" that the fistula takes through the tissue.

In some cases the fistula is temporarily covered, for example a fistula caused by cleft palate is often treated with a palatal obturator to delay the need for surgery to a more appropriate age. Cleft lip (cheiloschisis and cleft palate (palatoschisis which can also occur together as cleft lip and palate are variations of a type of clefting Congenital A palatal obturator is a Prosthesis that totally occludes an opening such as an oronasal Fistula (in the roof of the mouth)

Surgery is often required to assure adequate drainage of the fistula (so that pus may escape without forming an abscess). Pus is a whitish-yellow yellow or yellow-brown substance produced during Inflammatory responses of the body that can be found in regions of Pyogenic bacterial An abscess (abscessus is a collection of Pus (dead Neutrophils) that has accumulated in a cavity formed by the tissue on the basis of an infectious process Various surgical procedures are commonly used, most commonly fistulotomy, placement of a seton (a cord that is passed through the path of the fistula to keep it open for draining), or an endorectal flap procedure (where healthy tissue is pulled over the internal side of the fistula to keep feces or other material from reinfecting the channel). A Fistulotomy is the surgical opening or removal of a fistulous tract A seton or seton stitch is a medical term for a procedure used to aid the healing of fistulae. Treatments involving filling the fistula with fibrin glue or plugging it with plugs made of porcine small intestine submucosa have also been explored in recent years, with variable success. Surgery for anorectal fistulae is not without side effects, including recurrence, reinfection, and incontinence.

It is important to note that surgical treatment of a fistula without diagnosis or management of the underlying condition, if any, is not recommended. For example, surgical treatment of fistulae in Crohn's disease can be effective, but if the Crohn's disease itself is not treated, the rate of recurrence of fistula is very high (well above 50%). Crohn's disease is a Disease of the Digestive system which may affect any part of the Gastrointestinal tract from Mouth to Anus

Therapeutic use

In end stage renal failure patients, a cimino fistula is often deliberately created in the arm by means of a short day surgery in order to permit easier withdrawal of blood for hemodialysis. Chronic kidney disease (CKD also known as chronic renal disease, is a progressive loss of renal function over a period of months or years A Cimino fistula, also Cimino-Brescia fistula, surgically created arteriovenous fistula and (less precisely arteriovenous fistula (often Abbreviated In Medicine, hemodialysis (also haemodialysis) is a method for removing waste products such as Potassium and Urea, as well as free water

As a radical treatment for portal hypertension, surgical creation of a portacaval fistula produces an anastomosis between the hepatic portal vein and the inferior vena cava across the omental foramen (of Winslow). In Medicine, portal hypertension is Hypertension (high blood pressure in the Portal vein and its branches The hepatic portal vein (often portal vein for short is a Portal vein in the human body that drains blood from the Digestive system and its associated The inferior vena cava (or IVC is the large Vein that carries de-oxygenated Blood from the lower half of the body into the Heart. This spares the portal venous system from high pressure which can cause esophageal varices, caput madusae, and hemorrhoids.

See also

• Anastomosis

References

External links

• Campaign to End Fistula
• Cleveland Clinic - Anorectal Fistula
• Hemorrhoids In Plain English - Fistula-in-Ano
• Mayo Clinic - Arteriovenous Fistula
• American Urological Association - Bladder Fistula
• American Hearing Research Foundation - Perilymph Fistula
• Urinary Fistula
• Fistula

• The Fistula Foundation - Obstetric Fistulas
• Fistula Hospital in Ethiopia
• Washington Post article on fistulae in conflict areas in the Democratic Republic of the Congo
• “Congo's Wounds of War: More Vicious than Rape”, a Newsweek article on fistulae in conflict areas in the Democratic Republic of the Congo
• One by One - Funding Care for Women with Fistula
• Panzi Hospital of Bukavu in the Democratic Republic of Congo
• SUDAN: Fighting fistula in Khartoum, IRIN, 16 November, 2005
• NOVA: A Walk to Beautiful, May 18, 2008

An anastomosis (plural anastomoses, from gr ἀναστόμωσις communicating opening) is a Network of streams that both branch out and reconnect

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