Practice Essentials
A fistula is an abnormal communications between two epithelialized surfaces; thus an intestinal fistula is an abnormal anatomic connection between a part (or multiple parts) of the intestinal lumen and the lumen of another epithelialized structure or the skin. Intestinal fistula includes many clinical entities.
Because fistulas are widely defined, they are generally classified by anatomic, physiologic, and etiologic methods, all of which have treatment implications.
As a general rule in the treatment of intestinal fistulas, medical treatment and stabilization precede attempts at surgical intervention. In patients with all forms of enteric fistulas, sepsis is a major cause of mortality and must be treated aggressively. Surgical treatment is reserved for patients whose fistulas do not resolve with nonsurgical therapy. Aortoenteric fistulas, which mandate emergency surgery when diagnosed, are an exception.
The aim of surgical intervention is to restore gastrointestinal (GI) tract continuity, as well as to repair and restore function to the other involved structures. One surgical procedure may not suffice; staged surgical procedures may be required. Treatment should be individualized on the basis of the patient’s overall medical condition and radiologic and intraoperative findings.