gut fistulation

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A gastrointestinal fistula is an abnormal connection between the gut and another epithelial / endothealial - lined surface, such as another organ system, the skin surface, or elsewhere along the gastrointestinal tract. Some authors exclude fistulas involving the large bowel and esophagus when classifying or describing gastrointestinal fistulas.

Pathology

Gastro-intestinal fistulas can be congenital or acquired in nature. They are generally named according to their participating anatomic components, and virtually every imaginable combination has been reported. Examples include

gut - gut:
- enteroenteric fistula
- coloenteric fistula
- coloduodenal fistula
- cologastric fistula
gut - skin:
- enterocutaneous fistula
- gastrocutaneous fistula
- colocutaneous fistula
- certain perianal fistulas
gut - bladder:
- enterovesical fistula
- colovesical fistula / recto-vesical fistula
gut - ureter:
- ureterocolic fistula
- ureteroenteric fistula
- ureteroduodenal fistula
gut - kidney:
- renoenteric fistula
- renocolic fistula
gut - vagina:
- enterovaginal fistula
- colovaginal fistula
- anovaginal fistula
- rectovaginal fistula: commonest GI fistula involving the female genital tract
gut - biliary tract:
- cholecystoduodenal fistula: commonest to involve the biliary tract
- cholecystocolic fistula
- choledochoduodenal fistula
- choledochocolic fistula
gut - vascular system:
- aortoenteric fistula
- aortoduodenal fistula

Causes

Their causes can be as diverse as their types and include

acquired:
- common:
  - post-surgical: considered most common cause
  - Crohn disease
  - diverticulitis
- less common:
  - due to abdominal malignancies: colon cancer
  - radiation therapy
  - due to foreign bodies
  - intra-abdominal trauma
  - atypical intra-abdominal infections:
    - tuberculosis
    - histoplasmosis
    - actinomycosis
    - xanthogranulomatous pyelonephritis
    - amoebiasis
    - echinococcosis
    - lymphogranuloma venereum
  - cholecystitis
  - pancreatitis
  - appendicitis
congenital:
- congenital dorsal-enteric fistula: associated with split notochord syndrome
- congenital enteroenteric associated with an omphalocele