Fistulas
Last reviewed: 23.04.2024
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[What causes fistula?
The appearance of fistulas is associated with malformations, inflammatory and tumor processes, injuries and surgeries. In this regard, fistula divided into congenital and acquired. In relation to the environment distinguish: external, opening on the surface of the skin; Internal, not communicating with the external environment; and combined, when there is a communication between the internal organs and the skin, for example, bronchopleurotoral fistula, etc. According to the nature of the fistula that separates, there are: mucous; purulent, bile, intestinal, dairy, salivary, urinary, etc. Fistulas also denote the organ: gastric, intestinal, urinary, bronchial, esophageal, etc.
Congenital fistulas are always lined with epithelium, they are divided into median and lateral, full and incomplete. Incomplete fistulas, one of the ends of which are obliterated, are called diverticula of the esophagus, bronchus, bladder, ileum / (Meckel's diverticulum), etc. The most common in practice are the congenital fistulas of the neck: the median are associated with abnormalities of the thyroid gland; lateral - bronchogenic nature. Full umbilical fistula is associated with the unpaired umbilical passage or the urinary duct with a distinctive discharge. They must be differentiated from the umbilical cyst, which is characterized by a mucous discharge. Often there is an epithelial coccygeal course. Given their epithelial lining, they can not close themselves and require plastic surgery.
Acquired fistulas can be caused by various causes, but the most common ones are trauma and purulent-inflammatory processes, since pus always tries to break out. Epiphasically located abscesses and deep, in cases of erosion or damage to the fascia; Opened to the skin, forming a purulent fistula. If the exit to the skin is difficult for some reason, the abscesses are interconnected by internal fistulas, for example, ischiorectal, pelviorectal paraproctitis, zapad-like panaritium, etc. Pus can break through into adjacent hollow organs or body cavities, forming internal organ or interorgan fistula, for example, bronchopleural, esophageal and tracheal, etc. Tumors in the period of decay and some types of trauma can also give interorgan fistulas, for example, uterine-vesicle, intestinal, vaginal-rectal and other.
A distinctive feature of acquired fistula is that they have a granulating wall and do not have epithelial lining. Fistula lasts for a long time because of the abundant exudation of pus, excreta, especially active pus. As a result, when the primary focus is cut off or the inflammation fades in it, the fistulas are closed or covered themselves. But with an exacerbation of the chronic process in the hearth, they reopen, which, for example, happens in the fistulous form of chronic osteomyelitis.
How are fistulas diagnosed?
Diagnosis of external fistulas is not difficult. The presence of complaints, data of anamnesis, the presence of a hole on the skin with a characteristic detachable make it possible to diagnose. To determine the nature of the course, its connection with the tissues is performed by fistulography. To determine the course of the fistula during the operation, its dyeing is used. Laboratory examination of the contents of the fistula is shown.
Fistulas, formed by a specific infection, have features. When the lymph nodes or the gums are opened on the skin with tuberculosis, the formation of the fistula is accompanied by the formation of ulcers around it: the surrounding skin is thinned, cyanotically hyperemic, the fistula pallor is pale, the fistula openings and ulcers have characteristic bridges, separated by "curdled", heal with a rough scar, for a short time , then quickly recur. Fistulae with actinomycosis are painless, with poor in the form of millet grains detachable, around it is a painless inflammatory infiltrate.
Great difficulty is the diagnosis of internal fistulas, especially when joints fail. Primarily used dyes, more often indigocarmine or methylene blue, for example, to diagnose a gastric or intestinal fistula, the patient is given a drink of 10-20 ml of a dye, in the presence of a fistula, it will be released by drainage from the abdominal cavity; also the introduction of a dye in the bronchus and its isolation by drainage from the pleural cavity indicates the presence of a fistula. But in many cases it is necessary to carry out a comprehensive examination, including endoscopic and contrast X-ray studies.
A special group consists of artificial fistulas, created intentionally in an operative way with the purpose of restoring the patency of the hollow organ, removing the necessary contents of its contents or secret, and also providing the body with food. Depending on the indications, two types of artificial fistula (stoma) are formed: temporary, which heal independently after the need has passed, and permanent, necessary for long-term use. In these cases, create epithelial fistulas (guboid: full and incomplete), hemming the mucous membrane of the hollow organ to the skin. Of the stoma, tracheostomy, gastrostomy, colonostomy, enterostomy, cystostomy are most often imposed.