Fistulas

Question 1

What is a fistula?

Answer 1

Abnormal communication between two hollow organs or a hollow organ and the skin (i.e. 2 epithelial cell layers)

Question 2

What are the predisposing factors and conditions that maintain latency of a fistula?

Answer 2

HIS FRIEND:

High output fistula (> 500 cc/day); Intestinal destruction (> 50% of circumference); Short segment fistula (

Question 3

What is an enterocutaneous fistula?

Answer 3

Fistula from GI tract to skin

Question 4

What are the causes of an enterocutaneous fistula?

Answer 4

Anastomotic leak, trauma to bowel, Crohn’s disease, abscess, diverticulitis, inflammation, infection, inadvertent suture through bowel

Question 5

What is the workup for enterocutaneous fistula?

Answer 5

CT (rule out abscess or inflammatory process); Fistulagram

Question 6

What are the possible complications of an enterocutaneous fistula?

Answer 6

High-output fistula; malnutrition; skin breakdown

Question 7

What is the treatment for an enterocutaneous fistula?

Answer 7

NPO; TPN; drain abscess; rule out and correct underlying causes; may feed distally (or if fistula is distal, feed elemental diet proximally)

Question 8

Which enterocutaneous fistula closes faster: short or long?

Answer 8

Long fistula

Question 9

What is a colonic fistula?

Answer 9

Includes colovesical, colocutaneous, colovaginal, and coloenteric fistulas

Question 10

What are the most common causes of colonic fistula?

Answer 10

Diverticulitis, cancer, IBD, foreign body, radiation

Question 11

What is the most common type of colonic fistula?

Answer 11

Colovesical: often presents with recurrent UTIs (also pneumaturia, dysuria, fecaluria)

Question 12

How is the diagnosis of colonic fistula made?

Answer 12

Barium enema; cystoscopy

Question 13

What is the treatment for colonic fistula?

Answer 13

Segmental colon resection and primary anastomosis.

Repair/resection of the involved organ.

Question 14

What is a cholecystenteric fistula?

Answer 14

Connection between gallbladder and duodenum or other loop of small bowel due to large gallstone erosion, often resulting in SBO as the gallstone lodges in the ileocecal valve (gallstone ileus)

Question 15

What are the common causes of a gastrocolic fistula?

Answer 15

Penetrating ulcers, gastric or colonic cancer, Crohn’s disease

Question 16

What are the possible complications of gastrocolic fistulas?

Answer 16

Malnutrition and severe enteritis due to reflux of colonic contents into the stomach and small bowel with subsequent bacterial overgrowth

Question 17

What is a pancreatic enteric fistula?

Answer 17

Decompression of a pseudocyst or abscess into an adjacent organ (rare).
Usually done surgically or endoscopically to treat a pancreatic pseudocyst.

Question 18

What is an external pancreatic fistula?

Answer 18

Pancreaticocutaneous fistula: drainage of pancreatic exocrine secretions through the abdominal skin

Question 19

What is the treatment for an external pancreatic fistula?

Answer 19

NPO, TPN, skin protection, octreotide

Question 20

What is a refractory pancreatic fistula?

Answer 20

Pancreaticocutaneous fistula that does not resolve with conservative medical management

Question 21

What is the diagnostic test for refractory pancreatic fistula?

Answer 21

ERCP to define site of fistula tract

Question 22

How is refractory tail of a pancreas fistula treated?

Answer 22

Resection of the tail of the pancreas and the fistula

Question 23

How is refractory head of a pancreas fistula treated?

Answer 23

Pancreaticojejunostomy

Question 24

What are the specific types of bladder fistulas?

Answer 24

Vesicoenteric: signs include pneumaturia, fecaluria.
Vesicovaginal: signs include urinary leak through vagina.