anatomy Anatomy () is the branch of morphology concerned with the study of the internal structure of organisms and their parts. Anatomy is a branch of natural science that deals with the structural organization of living things. It is an old scien ...

, a fistula (: fistulas or fistulae ; from

Latin Latin ( or ) is a classical language belonging to the Italic languages, Italic branch of the Indo-European languages. Latin was originally spoken by the Latins (Italic tribe), Latins in Latium (now known as Lazio), the lower Tiber area aroun ...

''fistula'', "tube, pipe") is an abnormal connection (i.e. tube) joining two hollow spaces (technically, two epithelialized surfaces), such as

blood vessel Blood vessels are the tubular structures of a circulatory system that transport blood throughout many Animal, animals’ bodies. Blood vessels transport blood cells, nutrients, and oxygen to most of the Tissue (biology), tissues of a Body (bi ...

intestine The gastrointestinal tract (GI tract, digestive tract, alimentary canal) is the tract or passageway of the digestive system that leads from the mouth to the anus. The tract is the largest of the body's systems, after the cardiovascular system. T ...

s, or other hollow organs to each other, often resulting in an abnormal flow of fluid from one space to the other. An

anal fistula Anal fistula is a chronic fistula, abnormal communication between the anal canal and the perianal skin. An anal fistula can be described as a narrow tunnel with its internal opening in the anal canal and its external opening in the skin near the a ...

connects the

anal canal The anal canal is the part that connects the rectum to the anus, located below the level of the pelvic diaphragm. It is located within the anal triangle of the perineum, between the right and left ischioanal fossa. As the final functional s ...

to the perianal skin. An anovaginal or rectovaginal fistula is a hole joining the anus or

rectum The rectum (: rectums or recta) is the final straight portion of the large intestine in humans and some other mammals, and the gut in others. Before expulsion through the anus or cloaca, the rectum stores the feces temporarily. The adult ...

to the

vagina In mammals and other animals, the vagina (: vaginas or vaginae) is the elastic, muscular sex organ, reproductive organ of the female genital tract. In humans, it extends from the vulval vestibule to the cervix (neck of the uterus). The #Vag ...

. A colovaginal fistula joins the space in the colon to that in the vagina. A urinary tract fistula is an abnormal opening in the urinary tract or an abnormal connection between the urinary tract and another organ. An abnormal communication (i.e. hole or tube) between the

bladder The bladder () is a hollow organ in humans and other vertebrates that stores urine from the kidneys. In placental mammals, urine enters the bladder via the ureters and exits via the urethra during urination. In humans, the bladder is a distens ...

and the

uterus The uterus (from Latin ''uterus'', : uteri or uteruses) or womb () is the hollow organ, organ in the reproductive system of most female mammals, including humans, that accommodates the embryonic development, embryonic and prenatal development, f ...

is called a vesicouterine fistula, while if it is between the bladder and the vagina it is known as a vesicovaginal fistula, and if between the

urethra The urethra (: urethras or urethrae) is the tube that connects the urinary bladder to the urinary meatus, through which Placentalia, placental mammals Urination, urinate and Ejaculation, ejaculate. The external urethral sphincter is a striated ...

and the vagina: a urethrovaginal fistula. When occurring between two parts of the intestine, it is known as an enteroenteral fistula, between the

small intestine The small intestine or small bowel is an organ (anatomy), organ in the human gastrointestinal tract, gastrointestinal tract where most of the #Absorption, absorption of nutrients from food takes place. It lies between the stomach and large intes ...

and the skin it is known as an enterocutaneous fistula, and between the colon and the skin as a colocutaneous fistula. A fistula can result from an infection, inflammation, injury or surgery. Many result from complications during childbirth. Sometimes a fistula is deliberately surgically created as part of a treatment, for example in the case of an arteriovenous fistula for

hemodialysis Hemodialysis, American and British English spelling differences#ae and oe, also spelled haemodialysis, or simply ''"'dialysis'"'', is a process of filtering the blood of a person whose kidneys are not working normally. This type of Kidney dialys ...

. The treatment for a fistula varies depending on the type, cause, and severity of the fistula, but often involves surgical intervention combined with

antibiotic An antibiotic is a type of antimicrobial substance active against bacteria. It is the most important type of antibacterial agent for fighting pathogenic bacteria, bacterial infections, and antibiotic medications are widely used in the therapy ...

therapy. In some cases the fistula is temporarily covered using a fibrin glue or plug. A catheter may be required to drain a fistula. Globally, every year between 50,000 and 100,000 women are affected by one or more fistulas relating to childbirth. Typically they are vaginal fistulas, between either the bowel or bladder and the vaginal canal, but uterine and bowel fistulas also occur. In

botany Botany, also called plant science, is the branch of natural science and biology studying plants, especially Plant anatomy, their anatomy, Plant taxonomy, taxonomy, and Plant ecology, ecology. A botanist or plant scientist is a scientist who s ...

, the term is most common in its adjectival forms, where it is used in binomial names to refer to a species that is distinguished by one or more hollow or tubular structures. '' Monarda fistulosa'', for example, has tubular flowers.Identification of Monarda fistulosa
subpage o
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, 2014. The term was first used in the 14th century.

Definition

A fistula is an abnormal connection between vessels or organs that do not usually connect. It can be due to a disease or trauma, or purposely surgically created.

Classification

Various types of fistulas include: * Blind: Only one open end; may also be called sinus tracts. * Complete: Both internal and external openings. * Incomplete: An external skin opening that does not connect to any internal organ. Although most fistulas are in forms of a tube, some can also have multiple branches.

Location

Types of fistula can be described by their location. Anal fistulas connect between the epithelialized surface of the anal canal and the perianal skin. Anovaginal or rectovaginal fistulas occur when a hole develops between the anus or rectum and the vagina. Colovaginal fistulas occur between the colon and the vagina. Urinary tract fistulas are abnormal openings within the urinary tract or an abnormal connection between the urinary tract and another organ such as between the bladder and the uterus in a vesicouterine fistula, between the bladder and the vagina in a vesicovaginal fistula, and between the urethra and the vagina in urethrovaginal fistula. When occurring between two parts of the intestine, it is known as an enteroenteral fistula, between the small intestine and the skin as an enterocutaneous fistula, and between the small intestine and the colon as a colocutaneous fistula. The following list is sorted by the

International Statistical Classification of Diseases and Related Health Problems The International Classification of Diseases (ICD) is a globally used medical classification that is used in epidemiology, health management and clinical diagnostics, diagnosis. The ICD is maintained by the World Health Organization (WHO), which ...

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

* (H04.6) Lacrimal fistula * (H05.81) Carotid cavernous fistula * (H70.1) Mastoid fistula ** Craniosinus fistula: between the intracranial space and a

paranasal sinus Paranasal sinuses are a group of four paired skeletal pneumaticity, air-filled spaces that surround the nasal cavity. The maxillary sinuses are located under the eyes; the frontal sinuses are above the eyes; the Ethmoid sinus, ethmoidal sinuses a ...

* (H83.1) Labyrinthine fistula ** Perilymph fistula: tear between the membranes between the middle and inner ears * Preauricular fistula ** Preauricular fistula: usually on the top of the cristae helicis of the ears

I: Diseases of the circulatory system

* (I25.4) Coronary arteriovenous fistula, acquired * (I28.0) Arteriovenous fistula of pulmonary vessels ** Pulmonary arteriovenous fistula: between an artery and vein of the

lungs The lungs are the primary organs of the respiratory system in many animals, including humans. In mammals and most other tetrapods, two lungs are located near the backbone on either side of the heart. Their function in the respiratory syste ...

, resulting in shunting of blood. This results in improperly oxygenated blood. * (I67.1) Cerebral arteriovenous fistula, acquired * (I77.0) Arteriovenous fistula, acquired * (I77.2) Fistula of

artery An artery () is a blood vessel in humans and most other animals that takes oxygenated blood away from the heart in the systemic circulation to one or more parts of the body. Exceptions that carry deoxygenated blood are the pulmonary arteries in ...

J: Diseases of the respiratory system

* (J86.0) Pyothorax with fistula * (J95.0) Tracheoesophageal fistula, between the

trachea The trachea (: tracheae or tracheas), also known as the windpipe, is a cartilaginous tube that connects the larynx to the bronchi of the lungs, allowing the passage of air, and so is present in almost all animals' lungs. The trachea extends from ...

and the

esophagus The esophagus (American English), oesophagus (British English), or œsophagus (Œ, archaic spelling) (American and British English spelling differences#ae and oe, see spelling difference) all ; : ((o)e)(œ)sophagi or ((o)e)(œ)sophaguses), c ...

. This may be

congenital A birth defect is an abnormal condition that is present at childbirth, birth, regardless of its cause. Birth defects may result in disability, disabilities that may be physical disability, physical, intellectual disability, intellectual, or dev ...

or acquired, for example as a complication of a

tracheostomy Tracheotomy (, ), or tracheostomy, is a surgical airway management procedure which consists of making an incision on the front of the neck to open a direct airway to the trachea. The resulting stoma (hole) can serve independently as an airway ...

K: Diseases of the digestive system

* (K11.4) Salivary gland fistula * (K31.6) Fistula of stomach and duodenum * (K31.6) Gastrocolic fistula * (K31.6) Gastrojejunocolic fistula – after a Billroth II a fistula forms between the transverse colon and the upper jejunum (which, post Billroth II, is attached to the remainder of the stomach). Fecal matter passes improperly from the colon to the stomach and causes halitosis. ** Enterocutaneous fistula: between the intestine and the skin surface, namely from the

duodenum The duodenum is the first section of the small intestine in most vertebrates, including mammals, reptiles, and birds. In mammals, it may be the principal site for iron absorption. The duodenum precedes the jejunum and ileum and is the shortest p ...

or the

jejunum The jejunum is the second part of the small intestine in humans and most higher vertebrates, including mammals, reptiles, and birds. Its lining is specialized for the absorption by enterocytes of small nutrient molecules which have been pr ...

or the

ileum The ileum () is the final section of the small intestine in most higher vertebrates, including mammals, reptiles, and birds. In fish, the divisions of the small intestine are not as clear and the terms posterior intestine or distal intestine may ...

. This definition excludes the fistulas arising from the colon or the appendix. ** Gastric fistula: from the stomach to the skin surface * (K38.3) Fistula of appendix * () Anal and rectal fissures and fistulas ** ()

Anal fistula Anal fistula is a chronic fistula, abnormal communication between the anal canal and the perianal skin. An anal fistula can be described as a narrow tunnel with its internal opening in the anal canal and its external opening in the skin near the a ...

** () Anorectal fistula (fecal fistula, fistula-in-ano): connecting the

or other anorectal area to the

skin Skin is the layer of usually soft, flexible outer tissue covering the body of a vertebrate animal, with three main functions: protection, regulation, and sensation. Other animal coverings, such as the arthropod exoskeleton, have different ...

surface. This results in abnormal discharge of

feces Feces (also known as faeces American and British English spelling differences#ae and oe, or fæces; : faex) are the solid or semi-solid remains of food that was not digested in the small intestine, and has been broken down by bacteria in the ...

through an opening other than the

anus In mammals, invertebrates and most fish, the anus (: anuses or ani; from Latin, 'ring' or 'circle') is the external body orifice at the ''exit'' end of the digestive tract (bowel), i.e. the opposite end from the mouth. Its function is to facil ...

. * (K63.2) Fistula of intestine ** Enteroenteral fistula: between two parts of the intestine * (K82.3) Fistula of

gallbladder In vertebrates, the gallbladder, also known as the cholecyst, is a small hollow Organ (anatomy), organ where bile is stored and concentrated before it is released into the small intestine. In humans, the pear-shaped gallbladder lies beneath t ...

* (K83.3) Fistula of

bile duct A bile duct is any of a number of long tube-like structures that carry bile, and is present in most vertebrates. The bile duct is separated into three main parts: the fundus (superior), the body (middle), and the neck (inferior). Bile is requ ...

** Biliary fistula: connecting the bile ducts to the skin surface, often caused by gallbladder surgery ** Pancreatic fistula: between the

pancreas The pancreas (plural pancreases, or pancreata) is an Organ (anatomy), organ of the Digestion, digestive system and endocrine system of vertebrates. In humans, it is located in the abdominal cavity, abdomen behind the stomach and functions as a ...

and the exterior via the

abdominal wall In anatomy, the abdominal wall represents the boundaries of the abdominal cavity. The abdominal wall is split into the anterolateral and posterior walls. There is a common set of layers covering and forming all the walls: the deepest being the vi ...

M: Diseases of the musculoskeletal system and connective tissue

* (M25.1) Fistula of

joint A joint or articulation (or articular surface) is the connection made between bones, ossicles, or other hard structures in the body which link an animal's skeletal system into a functional whole.Saladin, Ken. Anatomy & Physiology. 7th ed. McGraw- ...

N: Diseases of the urogenital system

* (N32.1) Vesicointestinal fistula * (N36.0) Urethral fistula ** Innora:between the prostatic utricle and the outside of the body * (N64.0) Fistula of nipple * (N82) Fistulae involving female genital tract /

Obstetric fistula Obstetric fistula is a medical condition in which a hole develops in the birth canal as a result of childbirth. This can be between the vagina and rectum, ureter, or bladder. It can result in incontinence of urine or feces. Complications may ...

** (N82.0) Vesicovaginal fistula: between the

and the

** (N82.1) Other female urinary-genital tract fistulae *** Cervical fistula: abnormal opening in the

cervix The cervix (: cervices) or cervix uteri is a dynamic fibromuscular sexual organ of the female reproductive system that connects the vagina with the uterine cavity. The human female cervix has been documented anatomically since at least the time ...

** (N82.2) Fistula of vagina to small intestine *** Enterovaginal fistula: between the

and the vagina ** (N82.3) Fistula of vagina to large intestine *** Rectovaginal: between the

and the vagina ** (N82.4) Other female intestinal-genital tract fistulae ** (N82.5) Female genital tract-skin fistulae ** (N82.8) Other

female genital tract fistulae An organism's sex is female (symbol: ♀) if it produces the ovum (egg cell), the type of gamete (sex cell) that fuses with the male gamete (sperm cell) during sexual reproduction. A female has larger gametes than a male. Females and mal ...

** (N82.9) Female genital tract fistula, unspecified

Q: Congenital malformations, deformations and chromosomal abnormalities

* (Q18.0) Sinus, fistula and cyst of branchial cleft **

Congenital A birth defect is an abnormal condition that is present at childbirth, birth, regardless of its cause. Birth defects may result in disability, disabilities that may be physical disability, physical, intellectual disability, intellectual, or dev ...

preauricular fistula: A small pit in front of the ear. Also known as an ear pit or preauricular sinus. * (Q26.6)

Portal vein The portal vein or hepatic portal vein (HPV) is a blood vessel that carries blood from the gastrointestinal tract, gallbladder, pancreas and spleen to the liver. This blood contains nutrients and toxins extracted from digested contents. Approxima ...

- hepatic artery fistula * (Q38.0) Congenital fistula of lip * (Q38.4) Congenital fistula of

salivary gland The salivary glands in many vertebrates including mammals are exocrine glands that produce saliva through a system of ducts. Humans have three paired major salivary glands ( parotid, submandibular, and sublingual), as well as hundreds of min ...

* (Q42.0) Congenital absence, atresia and

stenosis Stenosis () is the abnormal narrowing of a blood vessel or other tubular organ or structure such as foramina and canals. It is also sometimes called a stricture (as in urethral stricture). ''Stricture'' as a term is usually used when narrowing ...

with fistula * (Q42.2) Congenital absence, atresia and

with fistula * (Q43.6) Congenital fistula of

and

* (Q51.7) Congenital fistulae between

and digestive and urinary tracts * (Q52.2) Congenital rectovaginal fistula

T: External causes

* (T14.5) Traumatic arteriovenous fistula * (T81.8) Persistent postoperative fistula

Causes

* Disease: Infections including an anorectal abscess and inflammatory diseases including

Crohn's disease Crohn's disease is a type of inflammatory bowel disease (IBD) that may affect any segment of the gastrointestinal tract. Symptoms often include abdominal pain, diarrhea, fever, abdominal distension, and weight loss. Complications outside of the ...

and

ulcerative colitis Ulcerative colitis (UC) is one of the two types of inflammatory bowel disease (IBD), with the other type being Crohn's disease. It is a long-term condition that results in inflammation and ulcers of the colon and rectum. The primary sympto ...

can result in fistulas. Fistulas to the anus may occur in

hidradenitis suppurativa Hidradenitis suppurativa (HS), sometimes known as acne inversa or Verneuil's disease, is a long-term dermatological condition characterized by the occurrence of inflamed and swollen lesions, lumps. These are typically painful and break open, r ...

. In women, fistulas can also occur following pelvic infection and inflammation. Probed gastrocutaneous fistula tract

* Surgical and medical treatment: Complications from

surgery can lead to biliary fistulas. As well as being congenital or resulting from trauma, arteriovenous fistulas are created purposefully for

. Radiation therapy to the pelvis can lead to vesicovaginal fistulas. Persistent gastrocutaneous fistulas can develop after

gastrostomy A gastrostomy is the creation of an artificial external opening into the stomach for nutritional support or gastric decompression. Typically this would include an incision in the patient's epigastrium as part of a formal operation. When originall ...

. * Trauma: Prolonged childbirth can lead to fistulas in women, in whom abnormal connections may occur between the bladder and vagina, or the rectum and vagina. An

obstetric fistula Obstetric fistula is a medical condition in which a hole develops in the birth canal as a result of childbirth. This can be between the vagina and rectum, ureter, or bladder. It can result in incontinence of urine or feces. Complications may ...

develops when blood supply to the tissues of the vagina and the bladder (and/or rectum) is cut off during prolonged obstructed labor. 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 developed fistulae. In 2003, thousands of women in eastern Congo presented themselves for treatment of traumatic fistulas caused by systematic, violent gang rape, often also with sharp objects 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.Emily Wax, Washington Post Foreign Service. Saturday, October 25, 2003; Page A01 "A Brutal Legacy of Congo War"
/ref> Head trauma can lead to perilymph fistulas, whereas trauma to other parts of the body can cause arteriovenous fistulas.

Treatment

Treatment for fistula varies depending on the cause and extent of the fistula, but often involves surgical intervention combined with

therapy. In some cases the fistula is temporarily covered, using a fibrin glue or plug. Catheters may be required to drain a fistula. Surgery is often required to assure adequate drainage of the fistula (so that pus may escape without forming an

abscess An abscess is a collection of pus that has built up within the tissue of the body, usually caused by bacterial infection. Signs and symptoms of abscesses include redness, pain, warmth, and swelling. The swelling may feel fluid-filled when pre ...

). Various surgical procedures are 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). Management involves treating any underlying causative condition. For example, surgical treatment of fistulae in

can be effective, but if the Crohn's disease itself is not treated, the rate of recurrence of the fistula is very high (well above 50%).

Therapeutic use

In people with

kidney failure Kidney failure, also known as renal failure or end-stage renal disease (ESRD), is a medical condition in which the kidneys can no longer adequately filter waste products from the blood, functioning at less than 15% of normal levels. Kidney fa ...

, requiring dialysis, 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

. As a radical treatment for portal hypertension, surgical creation of a portacaval fistula produces an anastomosis between the

hepatic portal vein The portal vein or hepatic portal vein (HPV) is a blood vessel that carries blood from the gastrointestinal tract, gallbladder, pancreas and spleen to the liver. This blood contains nutrients and toxins extracted from digested contents. Appro ...

and the

inferior vena cava The inferior vena cava is a large vein that carries the deoxygenated blood from the lower and middle body into the right atrium of the heart. It is formed by the joining of the right and the left common iliac veins, usually at the level of the ...

across the omental foramen (of Winslow). This spares the portal venous system from high pressure which can cause esophageal varices, caput medusae, and hemorrhoids.

Epidemiology

Globally, every year between 50,000 and 100,000 women are affected by fistula relating to childbirth.

Botany

, the term is most common in its adjectival forms, where it is used in binomial names to refer to species that are distinguished by hollow or tubular structures. '' Monarda fistulosa'', for example, has tubular flowers; '' Eutrochium fistulosum'' has a tubular stem; ''

Allium fistulosum ''Allium fistulosum'', the Welsh onion, also commonly called bunching onion, long green onion, Japanese bunching onion, and spring onion, is a species of perennial plant, often considered to be a kind of scallion. The species is very similar ...

'' has hollow or tubular leaves, and '' Acacia seyal'' subsp. ''fistula'' is the subspecies with hollow spines.

Society and culture

The term was first used in the 14th century. A fistula plays a central role in

William Shakespeare William Shakespeare ( 23 April 1564 – 23 April 1616) was an English playwright, poet and actor. He is widely regarded as the greatest writer in the English language and the world's pre-eminent dramatist. He is often called England's nation ...

s play

All's Well That Ends Well ''All's Well That Ends Well'' is a play by William Shakespeare, published in the First Folio in 1623, where it is listed among the comedies. There is a debate about the date of its composition, with possible dates ranging from 1598 to 1608. ...

References

External links

* {{Authority control Animal anatomy Anatomical pathology Anatomical terminology Symptoms and signs

Definition

Classification

Location

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

I: Diseases of the circulatory system

J: Diseases of the respiratory system

K: Diseases of the digestive system

M: Diseases of the musculoskeletal system and connective tissue

N: Diseases of the urogenital system

Q: Congenital malformations, deformations and chromosomal abnormalities

T: External causes

Causes

Treatment

Therapeutic use

Epidemiology

Botany

Society and culture

See also

References

External links