“People with chronic digestive problems have a high risk of developing a fistula-Gastrointestinal Fistula

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A gastrointestinal fistula (GIF) is an abnormal opening of the digestive tract that allows gastric fluids to seep through the lining of the stomach or intestines. This can result in infection when it leaks into the skin or other organs. It occurs mostly after intra-abdominal surgery, which is surgery inside the abdomen. It is also established that people with chronic digestive problems have a high risk of developing a fistula.

Types

There are four main types of GIFs:

Intestinal Fistula: occurs when gastric fluid leaks from one part of the intestine to the other where the folds touch. 

Extraintestinal Fistula: occurs when gastric fluid leaks from your intestine to your other organs, such as your bladder, lungs, or vascular system.

External Fistula: occurs when gastric fluid leaks through the skin.

 Complex Fistula: is one that occurs in more than one organ.

Causes

There are several different causes of GIFs. They include:

Surgery Complications

Cancer

Radiation treatment for the abdomen

Bowel obstruction

Surgical suture problems

Incision site problems

Abscess

Infection

Hematoma 

Tumor

Malnutrition

Bowel infections such as diverticulitis, and vascular insufficiency

Trauma: physical trauma, such as gunshot or knife wounds that penetrate the abdomen

Symptoms and Complications 

Abdominal pain

Painful bowel obstruction

Fever

Elevated white blood cell count

People who have internal fistulas may experience:

Diarrhea

Rectal bleeding

Bloodstream infection or sepsis

Poor absorption of nutrients and weight loss

Dehydration

Worsening of the underlying disease

The most serious complication of GIF is sepsis, a medical emergency in which the body has a severe response to bacteria. This condition may lead to dangerously low blood pressure, organ damage, and death.

Seeking medical care

See a doctor if you experience any of these symptoms after surgery:

a significant change in your bowel habits

severe diarrhea

fluid leakage from an opening in your abdomen or near your anus

abdominal pain

Diagnosis

The doctor upon presentation in the hospital will:

Review your medical and surgical history and assess your current symptoms. 

Recommend several blood tests to assess the serum electrolytes 

Nutritional status, which is a measure of your levels of albumin and pre-albumin. 

Fistulogram may be done by injecting contrast dye into the opening in your skin and taking X-rays

An upper and lower endoscopy 

Upper and lower intestinal radiography

Ultrasound or CT scan can be used to find intestinal fistula or abscessed areas.

Magnetic resonance cholangiopancreatography (MRCP)

Treatment 

Fistulas are classified based on how much gastric fluid is seeping through the opening. Low output fistulas produce less than 200 milliliters of gastric fluid per day. High output fistulas produce about 500 milliliters per day.

Some types of fistulas close on their own when the:

infection is controlled

body absorbed enough nutrients

overall health is good

amount of gastric fluid is coming through the opening is small

The general treatments may include:

replenishing fluids

correction of the blood serum electrolytes

normalizing an acid and base imbalance

reducing the fluid output from your fistula

controlling infection and guarding against sepsis

protecting the skin and providing ongoing wound care.

 



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