Gastrointestinal Fistula – Everything you Need to Know

Overview

Gastrointestinal fistula (GIF) is an abnormal opening in your stomach or intestines which causes gastric fluid to leak through the lining of your stomach or intestines. This could lead to infections when such fluids seep into your skin or other organs.
This most commonly takes place after intra-abdominal surgery or in people with chronic digestive problems. The leaks from one part of the gastrointestinal tract to another are known as entero-enteral fistulas and the ones which connect the GI tract to the skin are known as entero-cutaneous fistulas.
A fistula is an abnormal connection between two hollow spaces such as blood vessels, intestines, or other hollow organs. Fistulas are usually caused by injury or surgery, but they can also result from an infection or inflammation.

What are the different types of gastrointestinal fistula?

This fistula is formed when an abnormal connection develops between the gastrointestinal tract and the skin, or any other organ. This results in the leakage of stomach acid. This medical condition is severe and requires long term care. There are four main types of GIF:

Intestinal fistula

In this type of fistula, gastric fluids leak out from one part of the intestine to another, where the folds touch. This is also called gut-to-gut fistula.

Extra-intestinal fistula

This type of fistula happens when the gastric fluid leaks out from the intestine to other organs, like bladder, lungs or vascular system.

External fistula

In this type, gastric fluid leaks out through the skin and is also known as cutaneous fistula. This will have an open area of the skin and the acid can harm the skin severely.

Complex fistula

This is a fistula which occurs in more than one organ.

Diagnosis of Gastrointestinal Fistula

To diagnose gastrointestinal fistula, the physician will perform the following tests:

1. Blood tests: Blood tests would involve assessing serum electrolytes and nutritional status. 
2. Upper and lower endoscopy: Through this test, the physician will be able to detect any abnormalities or problems inside the digestive tract by using an endoscope. 
3. Upper and lower intestinal X-ray: For this test, the patient is required to swallow barium if the fistula is suspected to be inside the stomach or the intestines. To diagnose colon fistula, the physician will perform a procedure known as barium enema.

Symptoms of Gastrointestinal Fistula

When a person has GIF, digested food material cannot freely move through the body. Your symptoms will depend on whether you have an internal or external fistula. It also depends on whether the patient has developed a complicated condition known as sepsis. In this condition, the person’s body attacks itself, as a response to severe bacterial infection. The symptoms of external fistulas include:

• Skin discharge
• Abdominal pain
• Fever
• Increased white blood cell count
• Painful bowel obstruction

Symptoms of internal fistulas are

• Diarrhea
• Blood stream infection
• Dehydration
• Rectal bleeding
• Poor absorption of nutrients and weight loss
• Worsening of the underlying disease

Causes of Gastrointestinal Fistula

There are several different reasons of developing gastrointestinal fistula. These include:

• Surgery complications: According to International Journal of Academic Medicine, about 85-90% of all GIF cases happen after intra-abdominal surgeries. Most fistulae appear during the first week post-surgery. Also, a follow-up and prompt diagnosis need to be done after the surgery.
• Spontaneous causes: In certain cases, Gastrointestinal Fistula occurs without a known cause. This is known as a spontaneous formation.
• Trauma: Physical trauma, like gunshot or knife wounds, which penetrate the abdomen could cause GIF to develop.

Treatment for Gastrointestinal Fistula

Gastrointestinal fistula treatment is mainly dependent on its severity & location. The right treatment could take weeks or even months to cure the condition. Your doctor will assess your fistula thoroughly to decide the likelihood of it closing on its own. Fistulae which are small and uninfected mostly close without any treatment. Fistulae situated in the colon take 30-40 days to close while those in the small intestine take 40-50 days. Treatments include:

• Gastrointestinal fistula surgical intervention: If you have sepsis, your doctor will suggest you to undergo surgery to repair the areas of drainage. Gastrointestinal fistula surgery is usually performed if three to six months of treatment do not make you better. Surgeries can be done via special drains, negative pressure therapy systems etc. to help the fistula drain out while healing. The negative pressure system makes the use of a vacuum to drain the excess fluid and improve blood flow to the area. Even endoscopic techniques may be used to glue or close the leaking parts of the fistula.
• Medications: When there is food in the gut, there is additional secretion of gastric juices which will prevent the patient from getting enough nutrients. So, alongside surgery, medicines and nutrients are given to help the body heal. Nutrients may be administered intravenously or medications like scopolamine, protein pump inhibitors, Pepcid or loperamide are prescribed to decrease the amount of fluid in the gut.
• Other treatment: Other treatments may be aimed at replenishing the blood serum electrolytes, reducing fluid output from fistula, controlling infection, preventing sepsis, normalizing acid-base imbalance and providing ongoing wound care.

Prevention of Gastrointestinal Fistula

Gastrointestinal fistulas can be caused by external physical trauma, or by an underlying medical condition. To fully prevent the onset of gastrointestinal fistulas, the best method is regular health checkups, and leading an active lifestyle, and avoiding a sedentary lifestyle. 

Complications of a Gastrointestinal Fistula

One of the major complications caused by a gastrointestinal fistula is sepsis. Sepsis is a condition in which the body has an adverse reaction to bacteria, resulting in low blood pressure, internal organ malfunctions, and at severe cases, even fatalities.

Conclusion

Gastrointestinal fistulas can turn out to be severe conditions which spontaneously resolve in people who are healthy and secrete smaller amounts of gastric fluid. But, at times, it does require treatment and could take a prolonged amount of time to get better. Together, early diagnosis, treatment, nutritional supports are crucial to reducing the mortality of gastrointestinal fistula.

FAQs

How serious is a fistula?

The severity of the fistula is determined by the amount of pain, discomfort and the location it forms in. The best way to understand the severity of any fistula is to get it checked by a physician.

What happens if a fistula is left untreated?

Usually, minor cases of fistula go away on their own without any treatment. However, if the symptoms and the discomfort increases, then it’s advised to get it checked by a physician.

Is fistula surgery urgent?

This depends on the severity of the fistula, and if it causes any symptoms that could lead to fatalities.