Types of intestinal fistulas. Classification: types and types

Intestinal fistulas are a surgical pathology, the frequency of diagnosis of which is gradually increasing, as intestinal ailments are increasingly developing inflammatory in nature. The essence of the problem is that in adults or children, unnatural connecting passages form between the intestines and other organs, as well as the skin.

There is only one reason for the appearance of the disease - necrosis of the intestinal wall, but a large number of predisposing factors can lead to this condition.

Symptoms of intestinal fistulas will depend on their location, morphological structure and the period of time that has passed since their formation.

The diagnosis can only be confirmed using various methods instrumental examination patient. The pathology is treated with surgical methods, but in addition conservative therapy will be used.

Etiology

An intestinal fistula is an unnatural hollow fistula tract that connects the lumen of the intestinal tube with other cavities human body, nearby authorities and skin.

The main cause of the pathology is necrosis of the walls of this organ, which occurs due to local cessation of blood supply. However, experts identify a large number of predisposing factors that can lead to such a process. Thus, fistulas in the intestines can be formed against the background of:

acute inflammation in the vermiform appendix;
intestinal tuberculosis;
intestinal diverticulum;
strangulated hernia;
various changes in the blood vessels of the mesentery;
penetrating or blunt trauma to the abdomen, leading to disruption of the integrity of the stomach or intestines;
complications after surgical intervention, among which it is worth highlighting - intestinal obstruction, the formation of interloop abscesses, failure of the sutures holding the wound;
actinomycosis;
radiation therapy aimed at treating cancer;
prolonged use of drainage systems;
Crohn's syndrome;
medical error during surgical therapy other diseases.

Classification

There are a large number of divisions of this disease. The first classification provides for several types of disease, depending on etiological factor. From this it follows that intestinal fistulas are:

congenital - in the vast majority of cases, they are the result of anomalies in the development of the intestinal tube or intestinal umbilical duct. Such pathological channels can connect the intestines with such organs as the scrotum, bladder and vagina;
acquired - half of them are due to postoperative fistulas, and the second half are caused by other etiological factors;
artificial - this means that they are created specifically in order to provide a patient with a serious illness with adequate nutrition through a tube, as well as for intestinal decompression.

According to their location, fistula tracts are:

high – the anomaly is localized near the duodenal process or in the mesenteric zone of the affected organ;
average;
low - the channel is located near the terminal part of the small intestine.

According to morphological features there are:

external intestinal fistulas - divided into complicated and uncomplicated;
internal - connect to anatomically nearby organs, which often leads to the formation of an intestinal-vaginal fistula, vesico-intestinal fistula and other types;
mixed - in this case, passages are formed both between organs and with the skin.

According to the degree of formation, pathology is divided into:

formed fistulas – have a clearly defined fistula tract. This type is also called a tubular fistula;
unformed or labiform fistulas.

Based on the passage of gastrointestinal contents, neoplasms are divided into:

full - the contents of the intestines are completely expelled;
incomplete - the contents come out partially.

The following can come out of the fistula canal:

slime;
feces;
pus;
mixed discharge.

Symptoms

Clinical signs of such a disease are characterized by several factors - time of occurrence, place of formation and structure:

formed fistulas – expressed in complete absence symptoms, while unformed canals show signs of severe intoxication and have a less favorable prognosis;
internal interintestinal fistulas also often form asymptomatically;
high fistulas are characterized by profuse diarrhea and progressive loss of body weight;
External intestinal fistulas have abnormal openings in the skin, of which large quantities the contents of the intestines leak out. This leads to the formation of dermatitis and maceration in a short period of time. Significant fluid loss leads to symptoms of dehydration, extreme exhaustion and multiple organ failure. Against this background, there is a decrease in blood pressure, increased heart rate, decreased daily urine output and dry skin;
rectal fistula is characterized by the manifestation of psychosis, sleep disturbances, increased excitement, depression and irritability;
low-formed fistulas do not lead to the loss of a large amount of fluid, which is why they are not so acute;
postoperative intestinal fistula is characterized by severe pain and copious discharge intestinal contents and pancreatic juices.

Diagnostics

Put correct diagnosis is possible only on the basis of instrumental examination data, but laboratory tests and an objective examination are necessary.

First of all, the doctor must:

get acquainted with the medical history and life history of the patient, which is necessary to identify the etiological factor;
Conduct a thorough physical examination of the fistula opening and finger examination fistula canal;
interview the patient regarding the first time of appearance and severity of symptoms of the disease.

To clarify the location of the canal formation, a laboratory study of the discharge is necessary to identify the presence in it of:

bilirubin;
pancreatic juices;
bile acids.

It is also mandatory to carry out tests with a dye - this substance is taken orally or administered through an enema. Depending on how much time has passed between the administration of methylene blue and its exit from the fistula canal, the location of the pathology formation is specified.

The basis of diagnostics aimed at clarifying the localization, as well as to identify internal fistulous tracts, may require:

Ultrasound of the abdominal cavity;
FEGDS;
radiography of the peritoneum, which is performed both with and without a contrast agent;
spiral CT;
irrigoscopy;
fistulography;
fibrocolonoscopy.

Treatment

Elimination of such a disorder always begins with the appointment of conservative methods, which include:

replenishment of fluid deficiency;
normalizing electrolyte balance;
elimination of the source of infection - in the presence of a purulent wound or skin dermatitis;
detoxification;
performing dressings using hypertonic solutions, as well as antiseptic ointments;
taking medications to reduce symptoms;
forming a barrier between the skin and the discharge from the canal - this is achieved using pastes, glue or polymer films. They also cover the fistula with napkins that have been soaked in egg white or milk. Mechanical protection is achieved through the use of aspirators and obturators, which prevent the discharge of secretions;
establishment of nutrition, both enteral and parenteral.

Such therapeutic methods also used to prepare the patient for surgery. Surgical treatment of intestinal fistulas involves excision of their tract simultaneously with the affected area of this organ and the application of anastomosis.

After surgery, you must follow the above recommendations.

Prevention and prognosis

The only way to avoid the appearance of intestinal fistulas is to carry out timely diagnosis and eliminate those ailments that can cause the development of pathology. To do this, you need to undergo a full medical examination every year.

Early detection of the fistula tract in 40% of cases makes it possible to close the tract independently while using conservative methods of therapy.

Fatal outcome after surgical treatment The disease is observed in 2–10% of all cases of intestinal fistulas. The main factors in the death of patients are multiple organ failure, blood poisoning, peritonitis and acute renal failure.

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An intestinal fistula is a pathological communication of the intestine with the surface of the skin or an internal organ.

Historical reference. The first resection of the intestine with opening of the abdominal cavity to close the external fecal fistula was performed by Roux (1828). In 1928 K. P. Sapozhkov suggested the simplest way surgical closure of an external fecal fistula by suturing the defect in the intestinal wall with purse-string and seromuscular sutures. A.V. Melnikov (1932) developed a method for extraperitoneal closure of fistulas.

Pathogenesis. Intestinal fistulas are formed as a result of a violation of the integrity of the intestinal wall with the subsequent release of its contents onto the surface of the body and into other hollow organs. In persons with external (especially high) small intestinal fistulas, this leads to severe disorders in the body, which is due to the action of a number of factors: 1) loss of intestinal contents; 2) eating disorders; 3) intoxication of the body due to the presence of a purulent-inflammatory process in the tissues surrounding the fistula.

The leading factor in developing pathophysiological changes is the loss of intestinal chyme with all its ingredients. With high small intestinal fistulas, up to 6-10 liters of digestive juices can be released. In patients, dehydration, loss of proteins, enzymes, electrolytes (potassium, sodium, chlorine, zinc, iron, etc.), bile, gastric and pancreatic juices rapidly progress. As a result, this leads to dehydration of the body, primarily due to the fluid in the extracellular space, and an increase in the hematocrit number.

A decrease in the volume of circulating fluid and a subsequent drop in systolic pressure are accompanied by a decrease in glomerular filtration and diuresis. To maintain it at a sufficient level, the production of aldosterone increases, under the influence of which sodium and chlorine are retained in the body, but the release of potassium increases, which gradually leads to hypokalemia. Digestion and absorption are disrupted in the intestines. Initially, this is compensated by the mobilization of glycogen reserves from the liver and muscles, and after its breakdown - proteins and fats.

The breakdown of cell mass is accompanied by the release of potassium from the cells. Due to existing oliguria sour foods metabolism are delayed in the body, shifting the blood reaction towards metabolic acidosis. The potassium content in the blood plasma increases. Gradually, profound disorders of the acid-base balance and almost all types of metabolism occur, the general and local immunity, the reparative capabilities of the body are sharply reduced. Along with the existing wound intoxication, especially in patients with formed fistulas, this contributes to the development of exhaustion, renal-hepatic and vascular failure with a fatal outcome in 6-40% of cases.

A more favorable course is observed with low formed small and large intestinal fistulas. The latter are not accompanied by dehydration, profound metabolic disorders, or exhaustion of patients. Long-term existence of complete fistulas leads to deep atrophic changes in the mucous membrane of the outlet intestine, which quite often causes a severe course of the postoperative period after surgical treatment for fistulas.

Classification

Intestinal fistulas are divided according to etiology, morphological feature, functions, existing complications.

According to etiology, congenital and acquired fistulas are distinguished. Congenital fistulas make up 1.5-2.5% of their total number and exist in two variants. The first option is characterized by underdevelopment of the final section of the intestine and opens directly on the surface of the body. In the second option, one of the loops of the small intestine communicates with the external environment through a diverticulum. More often, such fistulas open into the navel area and are the result of a non-unionized vitelline duct. Acquired fistulas can be traumatic, postoperative, or inflammatory. Traumatic fistulas are formed after penetrating stabs, gunshot wounds abdominal cavity, retroperitoneal space, closed abdominal injury. Postoperative fistulas account for more than 50% of all acquired fistulas. They are caused by undiagnosed injuries to the wall of a hollow organ (bruise, deserosis, hematoma, rupture), failure of the sutures of formed anastomoses, sutured wounds of the intestine, duodenal stump, resected small and large intestines; leaving in the abdominal cavity foreign bodies (gauze wipes, metal fragments, etc.). Special group postoperative fistulas are artificial fistulas. They are formed in the form of: 1) enterostomy for feeding patients (therapeutic fistulas) and intestinal decompression during acute intestinal obstruction, peritonitis; 2) unnatural anus in persons with tumors of the large intestine (discharge fistulas).

The appearance of inflammatory fistulas is associated with: 1) progression or occurrence after an inflammatory-destructive process in the abdominal cavity (peritonitis, appendicitis, gynecological diseases, diverticulosis of the large intestine, retroperitoneal phlegmon, tuberculosis, actinomycosis); 2) with spontaneous opening of the para-appendiceal abscess to the outside, self-resolution of the strangulated hernia; 3) with germination malignant tumor intestines of the abdominal wall.

According to morphological characteristics, fistulas are divided: by the nature of the existing message, by the degree of formation, by the structure of the fistula, by the number of available messages, by localization.

According to the nature of the existing communication, internal, external and mixed fistulas are distinguished. Internal intestinal fistulas form between the hollow organs of the abdominal cavity. External fistulas are a connection between hollow organs and the surface of the abdominal wall.

According to the degree of formation, unformed and formed fistulas are distinguished. Unformed fistulas include those characterized by direct opening of the intestinal lumen into a purulent or granulating wound, purulent cavity, fistulas, the mucous membrane of which is firmly fused with the skin. Formed fistulas have a clear connection with the external environment.

Based on their structure, they are distinguished between tubular and labiform. A tubular fistula is an isolated canal lined with granulation-scar tissue or integumentary epithelium, connecting the intestinal lumen with the skin. Its size and shape are variable. The fistula tract can be short or long, tortuous or straight, and have many internal and external openings. In some cases, there is a purulent cavity along its path. The outer diameter of a tubular intestinal fistula is significantly smaller than that of a labiform fistula. The main symptom of a labiform fistula is the direct fusion of the intestinal mucosa along the edge of the defect in its wall with the skin.

Depending on the number of available reports, fistulas can be single or multiple (on one loop, on different loops of the same or different parts of the intestine).

According to localization, fistulas are distinguished in the small intestine (duodenum, jejunum (high), ileum (low) intestines) and in the large intestine (cecum, ascending colon, hepatic flexure, transverse colon, splenic flexure, descending, sigmoid, rectum).

By function, complete and incomplete intestinal fistulas are distinguished. With complete fistulas, all intestinal contents flow out; with incomplete fistulas, a certain part of it passes into the efferent loop of the intestine. In some cases, spur formation leads to the formation of complete labial fistulas. It is a protrusion in the form of a jumper back wall intestines. There are false and true spurs. False spurs are movable, independently or under external influence they are reduced into the depths of the abdominal cavity. True spurs are firmly fixed. It is with a pronounced spur that the intestinal contents do not enter the intestinal outlet loop, but pour out.

Complicated fistulas may have: 1) local complications (purulent leaks, abscesses, phlegmon, bleeding from the fistula); 2) general complications(impaired water-salt and protein metabolism, renal failure, exhaustion).

Symptoms of intestinal fistulas

Internal intestinal fistulas, as a rule, do not manifest themselves in any way. However, with high small-colic anastomosis, progressive weight loss and diarrhea may be observed. The main symptom of external intestinal fistulas is the presence of holes in the skin through which intestinal contents are released. With high intestinal fistulas, it is liquid, yellow-green, foamy, with residues undigested food. The contents of low small intestinal fistulas are more viscous, while those of large intestinal fistulas are more formed. Along with the release of feces, gases are observed in patients with colonic fistulas. The skin around the external opening of the fistula is macerated and ulcerated. Patients with high, long-existing enteric fistulas are dehydrated and exhausted. Some of them lose up to 25-50% of their body weight. They are constantly worried about thirst.

There are changes in the neuropsychic sphere (excitement, irritability or, conversely, depression, adynamia, intoxication psychoses). The skin and visible mucous membranes of patients are dry. Blood pressure is reduced. Pulse quickened daily diuresis reduced. In the blood, an increase in hematocrit number, hypo- and dysproteinemia, a decrease in the total amount of electrolytes, an increase in urea, residual nitrogen, indirect bilirubin.

Formed colonic fistulas are not accompanied by such pronounced symptoms. Their main signs are the release of feces and inflammatory changes in the surrounding skin. Clinical manifestations external intestinal fistulas become more pronounced in the case of various complications: evagination of the afferent loop through the fistula with its strangulation; bleeding from the fistula; rejection of the intestine with a fistula from the abdominal wall with the development of peritonitis or purulent fecal leaks.

Diagnosis of intestinal fistulas. Examination of patients with intestinal fistulas includes visual examination of the wound with the fistula, the use of dyes, laboratory, X-ray and endoscopic methods research.

Inspection of the external opening of the fistula and its discharge, digital examination of the fistula tract gives the first idea of the localization and morphological characteristics fistula

The location of the fistula and its function can be assessed based on dye tests. Most often, the patient is given methylene blue to drink or given an enema with it. The level of presence of the intestinal fistula is judged by the time of appearance of the dye. B. To some extent, this is helped by determining the content of bilirubin, pancreatic enzymes, and urea in the fistula discharge.

The type and size of the fistula, the condition of the mucous membrane of the efferent segments of the intestine are established using endoscopic techniques - fibrocolonoscopy, fibrogastroscopy, etc., as well as x-ray examination. It includes a survey polypositional examination of the abdominal cavity, contrast methods: fistulography, passage of barium through the small intestine, irrigoscopy, computed tomography etc. Often these methods for diagnosing intestinal fistulas are combined.

Treatment of intestinal fistulas

As a rule, patients with intestinal fistulas are prescribed conservative treatment, which allows for healing of 40-50% of incomplete tubular and immature labiform fistulas. At the same time, this is a preparation for surgery in patients with formed labiform fistulas.

Complex conservative therapy includes: prescription of high-calorie nutrition, regulation of the secretory and motor functions of the gastrointestinal tract, elimination of homeostasis disorders existing in the body (disorders of protein, carbohydrate, fat metabolism, water-electrolyte balance, etc.), symptomatic therapy, local treatment. The latter involves stopping the purulent-inflammatory process in the tissues surrounding the fistula; protecting them from the effects of intestinal discharge; reducing or stopping the loss of intestinal contents.

To protect the skin from the action of intestinal secretions, physical, biochemical and mechanical methods are used. Physical methods are based on the use of Lassar paste, BF-2, BF-6 glue, silicone paste, and a polymerizing film, which is applied to the skin surrounding the external opening of the fistula. The basis of biochemical methods of protection is the neutralization of digestive juices: 1) tampons moistened with egg white, which are placed directly on the fistula; 2) constant irrigation of the wound with a solution of lactic acid (1 liter of isotonic sodium chloride solution + 4.7 liters of lactic acid solution), etc.

Mechanical methods are aimed at reducing or stopping the discharge from the fistula by blocking its external opening with various obturators, pelotas, occlusive valves and bandages, special devices. According to the period of use, obstructing devices are divided into temporary and permanent. Temporary obturation is carried out for a period of time limited period, permanent - for life. The latter method is most often used in patients with sigmostomas, when the obturator is removed only to remove feces and gases from the intestines.

Surgical intervention is performed to close non-healing tubular and almost all labiform fistulas against the background of conservative treatment. Planned operations are performed no earlier than 2-3 months. after healing of peritonitis.

Among all the methods of surgical treatment of intestinal fistulas, four types of operations are the most famous. Two of them are of historical significance and are used extremely rarely. Thus, the operation of fistula curettage is performed in patients with small tubular fistulas. Curettage is carried out only at the mouth of the fistula and its outer part. The operation of implanting the mouth and canal of the fistula into the peripheral intestine finds even fewer supporters and is sometimes performed for fistulas duodenum. .

The most widespread are various modifications of operations for resection of the section of intestine bearing the fistula (parietal, circular).

In cases of complex intestinal fistulas, it is more appropriate to use the operation of switching off (complete and incomplete) fistulas. The essence of the incomplete shutdown operation is to create an anastomosis between the part of the intestine leading to the fistula and the part of the intestine diverting from the fistula. When completely switched off, the afferent and efferent loops of the intestine are sutured between the anastomosis and the fistula, and then the switched-off part of the intestine along with the fistula is removed. Most often, this type of operation is used for multiple fistulas and in the case of high fistulas in patients with a rapidly deteriorating condition.

As surgical options for small incomplete tubular and labiform fistulas, extraperitoneal methods of closing them are used, and for the rest - intraperitoneal methods. The essence of extraperitoneal treatment methods is to isolate the wall of the fistula in the area of the fistula tract and suturing the defect with a double-row suture.

In the presence of complete external fistulas, a treatment method has also been developed by creating bypass anastomoses using permanent magnets. Permanent magnetic devices are inserted into the efferent and afferent sections of the intestinal loop bearing the fistula, under general anesthesia manually or instrumentally and are compared. This leads to compression of the connected sections of the intestinal wall. By the 5-7th day, the compressed tissues are rejected, and a seamless anastomosis is formed along the periphery of the compression zone. After the acute inflammation subsides both in the abdominal cavity and in the tissues surrounding the external opening of the fistula, and the general condition of the patients is normalized, a radical operation is performed to close the fistula.

The article was prepared and edited by: surgeon

The main complaints of patients are discharge of pus from the fistula openings on the skin or with feces during defecation, irritation and itching of the skin of the perineum, soiled underwear and exacerbation of pain during temporary closure of the fistula. From the anamnesis it is possible to determine the origin of the fistula and the nature of its treatment.

Diagnosis of intestinal fistulas

Upon examination, you can determine the location and number of external fistula openings, the nature of the discharge and the condition of the skin of the perineum. With a rectal examination, it is possible to determine the location of the fistula tract and the internal opening.

Passing a button probe allows one to identify a connection with the intestinal lumen and determine the location of the fistula in relation to the sphincter. If the fistula is located 2 cm higher from the anus, then, as a rule, the fistula is extrasphincteric. To identify the nature of the fistula, rectoscopy is used. If the internal opening cannot be identified, insertion into the fistula is used. methylene blue and by the coloring of the tampon previously inserted into the rectum, the location and nature of the fistula is judged.

The most accurate data is provided by fistulography after injection of iodolipol or other contrast agent into the lumen of the fistula.

Causes of fistulas

Intestinal fistulas are formed as a result of a violation of the integrity of the intestinal wall with the subsequent release of its contents onto the surface of the body and into other hollow organs.

In persons with external (especially high) small intestinal fistulas, this leads to severe disorders in the body, which is caused by a number of factors:

loss of intestinal contents;
eating disorders;
intoxication of the body due to the presence of a purulent-inflammatory process in the tissues surrounding the fistula.

The breakdown of cell mass is accompanied by the release of potassium from the cells. Due to existing oliguria, acidic metabolic products are retained in the body, shifting the blood reaction towards metabolic acidosis. The potassium content in the blood plasma increases. Gradually, profound disorders of the acid-base balance and almost all types of metabolism occur, general and local immunity suffers, and the reparative capabilities of the body sharply decrease. Along with the existing wound intoxication, especially in patients with formed fistulas, this contributes to the development of exhaustion, renal-hepatic and vascular failure with a fatal outcome in 6-40% of cases.

A more favorable course is observed with low formed small and large intestinal fistulas. The latter are not accompanied by dehydration, profound metabolic disorders, or exhaustion of patients. The long-term existence of complete fistulas leads to profound atrophic changes in the mucous membrane of the intestinal outlet, which quite often causes a severe course of the postoperative period after surgical treatment for fistulas.

Classification

Intestinal fistulas are divided according to etiology, morphological characteristics, function, and existing complications.

According to etiology, congenital and acquired fistulas are distinguished. Congenital fistulas make up 1.5-2.5% of their total number and exist in two variants. The first option is characterized by underdevelopment of the final section of the intestine and opens directly on the surface of the body. In the second option, one of the loops of the small intestine communicates with the external environment through a diverticulum. More often, such fistulas open into the navel area and are the result of a non-unionized vitelline duct. Acquired fistulas can be traumatic, postoperative, or inflammatory. Traumatic fistulas are formed after penetrating knife or gunshot wounds of the abdominal cavity, retroperitoneal space, or closed abdominal trauma. Postoperative fistulas account for more than 50% of all acquired fistulas. They are caused by undiagnosed injuries to the wall of a hollow organ (bruise, deserosis, hematoma, rupture), failure of the sutures of formed anastomoses, sutured wounds of the intestine, duodenal stump, resected small and large intestines; leaving foreign bodies in the abdominal cavity (gauze pads, metal fragments, etc.).

Special group postoperative fistulas constitute artificial fistulas. They are formed in the form:

enterostomies for feeding patients (therapeutic fistulas) and intestinal decompression
with acute intestinal obstruction, peritonitis;
unnatural anus in persons with tumors of the large intestine (discharge fistulas).

The appearance of inflammatory fistulas is associated with:

with the progression or occurrence after surgery of an inflammatory-destructive process in the abdominal cavity (peritonitis, appendicitis, gynecological diseases, ulcerative colitis, diverticulosis of the large intestine, retroperitoneal phlegmon, tuberculosis, actinomycosis);
with spontaneous opening of the periappendicular abscess to the outside, self-resolution of the strangulated hernia;
with germination of a malignant tumor of the intestine of the abdominal wall.

Based on their structure, tubular and labiform fistulas are distinguished. A tubular fistula is an isolated canal lined with granulation-scar tissue or integumentary epithelium, connecting the intestinal lumen with the skin. Its size and shape are variable. The fistula tract can be short or long, tortuous or straight, and have many internal and external openings. In some cases, there is a purulent cavity in its path. The outer diameter of a tubular intestinal fistula is significantly smaller than that of a labiform fistula. The main symptom of a labiform fistula is the direct fusion of the intestinal mucosa along the edge of the defect in its wall with the skin.

Depending on the number of available reports, fistulas can be single or multiple (on one loop, on different loops of the same or different parts of the intestine).

According to localization, fistulas are distinguished in the small intestine (duodenum, jejunum (high), ileum (low) and in the large intestine (cecum, ascending colon, hepatic flexure, transverse colon, splenic flexure, descending, sigmoid, rectum).

By function, complete and incomplete intestinal fistulas are distinguished. With complete fistulas, all intestinal contents flow out; with incomplete fistulas, a certain part of it passes into the efferent loop of the intestine. In some cases, spur formation leads to the formation of complete labial fistulas. It is a protrusion in the form of a jumper from the posterior wall of the intestine. There are false and true spurs. False spurs are movable, independently or under external influence they are retracted deep into the abdominal cavity. True spurs are firmly fixed. It is with a pronounced spur that the intestinal contents do not enter the intestinal outlet loop, but pour out.

Complicated fistulas may have:

local complications (purulent leaks, abscesses, phlegmon, bleeding from the fistula);
general complications (impaired water-salt and protein metabolism, renal failure, exhaustion).

Symptoms of intestinal fistulas

Internal intestinal fistulas, as a rule, do not manifest themselves in any way. However, with high small-colic anastomosis, progressive weight loss and diarrhea may be observed. The main symptom of external intestinal fistulas is the presence of holes in the skin through which intestinal contents are released. With high intestinal fistulas, it is liquid, yellow-green, foaming, with remnants of undigested food. The contents of low small intestinal fistulas are more viscous, while those of large intestinal fistulas are more formed. Along with the release of feces, gases are observed in patients with colonic fistulas. The skin around the external opening of the fistula is macerated and ulcerated. Patients with high, long-existing small intestinal fistulas are dehydrated and exhausted. Some of them lose up to 25-50% of their body weight. They are constantly worried about thirst.

There are changes in the neuropsychic sphere (insomnia, agitation, irritability or, conversely, depression, adynamia, intoxication psychoses). The skin and visible mucous membranes of patients are dry. Blood pressure is reduced. The pulse is increased, daily diuresis is reduced. In the blood, an increase in hematocrit number, hypo- and dysproteinemia, a decrease in the total amount of electrolytes, an increase in urea, residual nitrogen, and indirect bilirubin are determined.

Formed colonic fistulas are not accompanied by such severe symptoms. Their main signs are the release of feces and inflammatory changes in the surrounding skin. Clinical manifestations of external intestinal fistulas become more pronounced in the case of various complications: evagination of the afferent loop through the fistula with its strangulation; bleeding from the fistula; rejection of the intestine with a fistula from the abdominal wall with the development of peritonitis or purulent fecal leaks.

Treatment of intestinal fistulas

Conservative and surgical treatment of fistulas of the rectum and anus is used. Conservative methods consist of cauterizing the fistula tracts and introducing disinfectants into them. For cauterization, silver nitrate and iodine tincture are used. The end of the button probe is heated and immersed in crystals or on a stick of silver nitrate. A drop forms at the end of the probe, cools and solidifies. After this, the tip of the probe is inserted into the fistula tract and the probe is passed back and forth. Lapis dissolves and cauterizes the wall of the fistula tract. Iodine tincture in an amount of 0.5 ml is injected with a syringe without a needle into the external opening of the fistula once every 7 days for a month. Some top scores observed with a combination of washing the fistula with antibiotics and cauterization. Similar treatment is indicated for fresh fistulas or in the presence of absolute contraindications for surgical treatment of fistula. For chronic fistulas, conservative treatment does not lead to their healing.

Surgical treatment of rectal fistulas is possible in the clinic and in the hospital. Outpatient operations are permissible only for simple fistulas that have a straight course and are located inside the sphincter.

Under local anesthesia, the fistula is dissected using a previously inserted button-shaped probe. The wound is packed with Vishnevsky ointment and a T-shaped bandage is applied. The patient is taken home by ambulance and prescribed opium tincture for 5-6 days. After 2-3 days, the dressing is performed at home or in the clinic. If the tampon falls out of the wound, then its edges are separated and a gauze turunda with Vishnevsky ointment is inserted between them. In the future, dressings are performed after a warm sitz bath with a solution potassium permanganate. This operation gives about 70% recovery. Failures occur when the wound edges seal early. To prevent this unfavorable moment, the Gabriel operation is performed. A skin flap is excised in the form of an isosceles triangle, located with its base on the outside.

Intestinal fistula is a connection between the intestinal lumen and the surface of the body or the lumen of another hollow organ. In most cases, enteric fistulas (FI) open into the free abdominal cavity (29-32%), through the cavity of the abscess they open in 24.3% of cases, through a wound - 9.3%.Mortality in the development of TS in early postoperative period is 16.5-57.5%, and in acute period(unformed intestinal fistulas) - 20.0-80.0%, with high TC - 82-90%. With the development of fistulas on intestinal loops, mortality reaches 100%, with established fistulas - 4%, with failed ones - 71.7%.

Main causes of death: progressive peritonitis, sepsis, intoxication.

With TS, 2 dangerous pathogenetic directions are formed: peritonitis, sepsis, which require maximum mobilization of the body's resources, and fistula, which not only causes quick loss protective resources, but also makes it impossible to adequately replenish them due to impaired enteral nutrition.

One of the results of untimely treatment of an abscess is a breakthrough of the latter both into the intestine and out, which leads to the formation of a fistula; development of fixed eventration: high, unformed TS are formed on intestinal loops attached to the edges of the laparotomy wound with fixed eventration. They are often connected to purulent cavities and are located in the intestinal conglomerate. The latter fact leads to disruption of the passage in the conglomerate, which supports the existence of the fistula and leads, in turn, to significant losses of chyme. As a result, dehydration, exhaustion and intoxication develop, which requires urgent closure of the fistula; staged treatment of developed peritonitis, on the one hand, creates conditions for timely control and correction of the development of complications, on the other hand, it increases the risk of developing fistulas; others (trauma, acute appendicitis, strangulated hernia, perforation of hollow organs, obstetric and gynecological pathology) (32%).

Symptoms of intestinal fistula

Patients quickly lose weight and develop septic fever. Additionally Negative influence introduces absorption of decay products of the patient's tissues, resulting from the corroding action of intestinal secretions released from the fistula. Another mechanism of pathological disorders at the stage of fistula development (10-14 days) are disorders associated with the presence of peritonitis. As a rule, all patients develop blood hyperviscosity syndrome. One of the important mechanisms of disorders metabolic processes is the absence or insufficient absorption of nutrients as a result of partial and especially complete exclusion of the distal parts of the intestinal tube from the passage.

Predictors of the formation of intestinal fistulas are following symptoms: rise in temperature, refusal of enteral nutrition, anxiety, non-localized abdominal pain in the absence of changes in other organs. On days 2-3, intestinal contents mixed with pus appear in the wound.

Diagnosis of intestinal fistula

Direct diagnosis of a fistula is not difficult: the appearance of intestinal secretions in a wound or through drainage is an unambiguous criterion for the diagnosis of an intestinal fistula. The nature of the discharge depends on the level of the fistula. Therefore, determining the nature of the discharge from the fistula allows us to obtain preliminary knowledge of the degree of location of the fistula.

Diagnosis is more difficult in cases where the discharge from the wound does not have the character of intestinal chyme, but there is a change in the color of the exudate to yellowish, or there is persistence of a limited purulent focus in the abdominal cavity without a tendency to regression. If the nature of the exudate changes, wait-and-see tactics are used with dynamic monitoring of the patient. The dynamics of the general condition (temperature reaction, the appearance of symptoms of intoxication) and local manifestations(appearance of infiltrate, change appearance wounds). As a rule, within 2-3 days the clinical picture becomes clearer. For persistent ulcers, fistulography is performed, which makes it possible to establish the correct diagnosis.

Examination with dyes not only allows you to diagnose a fistula, but also determine the length of the afferent loop. The most popular is examination with methylene blue, taken per os. It takes 3-4 minutes to evacuate methylene blue from the stomach to the duodenum. Subsequently, the rate of movement of the dye through the intestines is 10 cm/min. It should be noted that determining the length of the afferent loop by the time that elapses from the moment the dye is consumed until the moment it is released from the fistula is an imprecise method, since various pathological processes have different effects on intestinal motility. Therefore, other methods have been developed to determine the length of the drive loop: a thread is tied to a metal ball, which is attached to a spool. The patient swallows the ball. As the latter passes through the intestine, the thread unwinds. After the ball comes out of the fistula, measure the length of the thread that came out and the length of the thread remaining on the spool. The length of the afferent loop is determined by subtracting from the total length of the thread the sum of the lengths of the threads located outside the gastrointestinal tract and stomach.

With TS contrast agent administered through the mouth and study the passage. For colonic fistulas, irrigoscopy is performed; with fistulography, contrast is injected directly into the fistulous tract.

At plain radiography pay attention to the condition of the pneumatized zones of the gastrointestinal tract, especially in the area where the fistula tract is located.

Fistulography is the next and important step in x-ray examination. Fistulography is performed as early as possible, but not earlier than 5-6 days after the operation.

X-ray examination of a passage of contrast taken per os is carried out if high fistulas are suspected. The intervals for repeat X-rays depend on the speed of passage of the contrast and the location of the fistula. As a rule, the higher the fistula is located, the shorter the intervals should be. The average interval between repeated radiographs is 20-30 minutes. An important point X-ray diagnostics, which is important both for predicting the possibility of self-closure of the fistula and for choosing surgical tactics, is determining the patency of the distal parts of the small intestine.

Conservative treatment of intestinal fistula

Infusion therapy. Correction of EBV may require infusion support in a daily volume of 4-7 liters. The infusion includes colloidal preparations, protein preparations, anticoagulants. Efficiency infusion therapy assessed on the basis of improvement in the general condition of patients and improvement in rheological parameters: blood viscosity, its fluidity limits, erythrocyte aggregation coefficient.

Drug therapy. For high and duodenal fistulas, sandostatin is used for treatment, which reduces discharge from the fistulas.

Ensuring the completeness of passage through the gastrointestinal tract. With a complete fistula, the main task is to restore intestinal passage. Special devices are used to capture chyme from the afferent loop and feed it into the outlet loop. The second method is the use of tube feeding.

The basic principle is dry nutrition and fractional meals. Protein food is prescribed with a limit on the amount of liquid taken to 400-500 ml/day (dry feeding method), since such nutrition is accompanied by a weak juice effect. This diet also reduces intestinal motility. Plant foods, which are rich in toxins, accelerate intestinal motility and stimulate secretion, are eliminated from food products. Liquid and thick foods are consumed separately, meals are carried out in fractional portions. Parenteral nutrition includes vitamin therapy, anabolic hormones, small doses of insulin. An important point is, if possible, the introduction of collected secretions into the outlet loop through a catheter. Among food mixtures, uncontrolled studies have shown that elemental mixtures are more effective than polymer ones.

To choose a treatment method, the type of fistula matters, in particular - formed or unformed. Conservative therapy or surgical treatment of established fistulas gives good results. The use of active surgical tactics for failed fistulas is based on the following principles: after 2 weeks, signs of peritonitis regress, signs of general inflammatory response syndrome regress, and local signs inflammation, granulations appear. Such results allow suturing the intestine.

Surgical tactics for intestinal fistula

There are 2 surgical tactics for failed small intestinal fistulas (FIF): one-stage and two-stage. Mortality when using one-stage tactics is 65%, when using two-stage tactics - 33%. The main causes of death are multiple organ dysfunction syndrome (MODS) and sepsis.

Suctions are widely used abroad, which allow the most complete suction of intestinal contents from the afferent loop with its subsequent introduction into the outlet loop. At the same time, a clear accounting of the removed and returned fluid is carried out. The use of the device makes it possible to achieve complete closure of the fistula in some patients with formed TS, and to prepare other patients for elective surgery. Today, an obturation-aspiration device is offered for temporary closure of the fistula: the device consists of a foam rubber sponge and several medical tubes passed through it and inserted into the cavity of the fistula. Through the tubes, active aspiration of intestinal contents and washing solutions is carried out.

Early surgical treatment is one of the most controversial issues surgical correction TS. On the one hand, the persistence of inflammatory changes in the peritoneum as a consequence of peritonitis and the failure of attempts to suture intestinal defects is a powerful deterrent to the use of early surgical correction. On the other hand, rapid exhaustion of the patient due to excessive losses intestinal juice and the absence of an adequate passage requires the surgeon to carry out adequate corrective interventions aimed at eliminating the root cause of water-electrolyte and metabolic disorders.

Views on the timing of operations in such patients are ambiguous: some scientists believe that surgical treatment of failed duodenal and high TS that arose against the background of peritonitis should be carried out as early as possible, before the development of irreversible metabolic and morphological changes. Others are of the opinion that early surgical treatment of intestinal fistulas should be avoided. Early surgical treatment should be limited only to emergency intervention in the formation of intra-abdominal abscesses, the development of bleeding or peritonitis. Surgical closure of the fistula during emergency operations is not recommended. However, this approach does not reduce the loss of intestinal chyme and restore adequate passage. Therefore, early surgical correction should be performed, but according to strictly verified indications. The following factors influence the establishment of indications for early surgical correction:

Localization of the fistula: the more proximal the fistula, the more often there is a need for early surgical correction;

The flow rate of losses through the fistula: the greater the flow rate, the more often there is a need for early surgical correction.

Increasing losses of chyme, disorders of all types of metabolism, and progressive exhaustion of the body in patients with high intestinal fistulas do not leave room for wait-and-see tactics and require urgent surgical correction. One of the indications for early surgery is the inability to ensure artificial continuity of the intestinal passage during the formation of an artificial complete fistula.

Deadlines for deferred operations. Average term the execution of operations ranges from 1-1.5 to 4-5 months. from the moment of fistula formation. According to other specialists, the use of programmed sanitation made it possible to eliminate peritonitis within 7-28 days. The operation to close the fistula was carried out within 1-12 days from the attenuation of peritonitis, fistulas of the duodenum and the hungry intestine were eliminated 4-12 days after the attenuation of peritonitis, fistulas ileum- on days 1-12 (in such patients, resection of the small intestine with ileostomy was performed).

Operational access. Based on the nature of the access, all treatment methods that are aimed at closing the fistula are divided into extraperitoneal and intraperitoneal. Most retroperitoneal methods are not used today and are of historical interest. The main advantage of retroperitoneal methods is that they are less traumatic.

An important point when performing the operation is adhesiotomy. During the operation, it is necessary to dissect all adhesions, eliminate deformations, double-barreled guns. Only after restoration of intestinal patency do they begin to eliminate the fistula itself.

First, adhesions distal to the fistula are eliminated - this reduces the traumatic nature of the operation and the risk of complications associated with adhesiotomy with adequate restoration of patency. Proximal adhesions are separated only when strict indications(the need for intestinal intubation, obvious signs of obstruction).

Surgical tactics for advanced peritonitis resulting from incompetent sutures depend on several factors:

Localization of the fistula;

Timing of diagnosis of peritonitis (peritonitis stage).

The main task in the treatment of peritonitis resulting from suture failure is the radical elimination of the source of peritonitis. The defect is sealed by repeated suturing after excision of the edges of the defect.

If it is impossible to radically eliminate the source of peritonitis (it is impossible to suture the intestine due to pronounced inflammatory changes - as a rule, with late (72 hours or more) diagnosis of peritonitis), a minimal amount of surgery is used - delimiting the source of failure by tamponing (9.7% of cases) or jejunostomy removal (29.1%).

The diversity of the morphology of intestinal fistulas and the clinical and morphological situations that are the background for the occurrence of fistulas make it impossible to introduce clear standards of treatment for patients with intestinal fistulas. However, the implementation and strict adherence to the basic principles of both conservative and surgical treatment of TS will significantly increase the patient’s chances of positive result. The main criterion in choosing between conservative and surgical treatment of a fistula is early stages is to predict the rate of negative metabolic disorders in the patient and the possibility of their correction. If control of the fistula is successful, and metabolic disorders are corrected adequately, then the timing of surgical intervention is determined by local morphological changes, primarily, the severity of inflammatory changes in the peritoneum, which can affect the development of incompetent intestinal sutures during repeated intervention. If adequate control over the fistula cannot be achieved, then the risk of irreversibility of metabolic disorders in such patients will be higher than the risk of surgical correction aimed either at restoring adequate intestinal passage or at forming a controlled intestinal fistula. The third important criterion is the localization of the fistula: the more distally the fistula is localized, the higher the efficiency of the formation of obstructive artificial intestinal fistulas. Proximal localization of fistulas requires, first of all, to ensure continuity of intestinal passage and minimize the loss of intestinal contents. A special place is occupied by fistulas of the duodenum, since in such cases the operations of bypassing the intestinal passage by forming a gastroenteroanastomosis with the simultaneous exclusion of the duodenum from the passage are quite effective.

In general, the complexity of the problem of treating failed small intestinal fistulas requires a collective approach in organizing healing process when major decisions are made through commission inspections with development therapeutic tactics depending on the specific clinical situation.

Analysis of the results allows us to draw the following conclusions: the same mortality rate in the early (3-17 days) stages of treatment of fistulas when using conservative and surgical approaches indicates the adequacy of the choice of treatment tactics. At the first stage important has a prognosis for the likelihood of spontaneous closure of the fistula against the background of conservative therapy. At the same time, with delayed (after 4-6 weeks) operations, a fairly high postoperative mortality rate is observed (71.5%). Obviously, operations at this stage were performed forcedly, when it was not possible to provide nutritional support and maintain the vital functions of the body at the required level.

In the first 2 weeks of the fistula’s existence, the following questions are most important for determining surgical tactics: 1) the chances of eliminating the fistula with conservative treatment; 2) what are the chances of maintaining the vital functions of the body at the proper level for a long time in order to perform the operation in the late (after 1.5-6 months) period.

A positive prognosis for spontaneous closure of the fistula without the development of severe late and nutritional disorders during the treatment period is the most favorable situation. In such patients, conservative therapy is indicated. If the chances of self-closure of the fistula are insignificant, then the following tactics are considered rational: in patients in whom the prognosis of adequate nutritional support and long-term conservative treatment is positive, conservative therapy is carried out until the signs of acute inflammation are eliminated to the maximum and EBV and protein disorders are corrected. Operations to eliminate the fistula in such patients are performed in the late (after 2-6 months) period. If adequate nutritional support is not possible, and the risk of developing severe water-electrolyte and organ disorders caused by both the fistula and the main pathological process, high, then such patients are indicated for early (in the first 3-17 days) surgical correction.

An intestinal fistula is a pathological opening in the wall that connects to a hollow organ or body surface. Intestinal fistulas can be internal or external. In the first case, they rarely manifest themselves characteristic symptoms. As for external ones, they are diagnosed if there is a channel on the skin through which feces and gases pass. In addition, the patient sharply loses weight and has multiple organ failure syndrome. For staging final diagnosis X-ray, endoscopic and laboratory examinations are prescribed. Non-surgical methods therapy is appropriate for tubular fistulas, as well as at the time of the preparatory stage for operations for spongy fistulas.

More about the disease

Intestinal fistula is a pathology that rapidly progresses due to an increase in the number inflammatory processes in the intestines. The latter most often entail the formation of unnatural communications. This disease can be congenital, acquired or artificial form. The first surgical intervention for intestinal fistula was performed in the 18th century. In modern medicine they are used different methods surgical treatment of such pathology.

Causes

The most basic reasons for the maturation of a fistula include complications that appear after surgery. An uncommon cause of this pathology is embryonic growth disorders. Fistula tracts that appear between the intestines and other organs entail serious violations in organism. Pathogenetic mechanism The development of multiple organ failure syndrome (MODS) is related to the loss of stomach or intestinal contents, problems associated with the absorption of nutrients, and intoxication that occurs due to inflammation in the area of the fistula.

Fistulas small intestine are considered the most dangerous, since up to 10 liters of liquid can flow through them per day, which leads to dehydration of the body and loss of digestive juices and enzymes. Due to dehydration, there is a loss of blood that passes through the kidney channels. The production of aldosterone increases, as a result of which potassium is actively washed out. In addition, the process of absorption of biologically significant elements in the intestine is disrupted.

Initially, the body's energy resources are covered by the breakdown of glycogen reserves in the liver and muscles, after which catabolic processes are launched, which involve the consumption of protein and fat reserves. Against the background of excessive dissimilation, cell breakdown is observed, which entails the accumulation of potassium, toxic metabolic waste. As a result of such phenomena, the kidneys are subjected to special stress. Exhaustion and MODS develop, which leads to death in 40% of cases.

Fistula in the large intestine and the one that forms in thin section, do not often entail obvious dystrophic disorders. A large volume of nutrients and fluid is absorbed in the upper part. That is why the loss of fluid at the level of the distal parts of the digestive tube does not entail serious dehydration, lack of nutrients and exhaustion of the patient’s body. A serious problem with low intestinal fistulas is a pathological condition in which the mucous membrane of the intestinal outlet suffers.

Types of intestinal fistulas

Intestinal fistulas are divided into congenital and acquired. The first option is extremely rare. As a rule, this pathology is caused by insufficient development of the intestinal tube or a cleft of the enterovesical duct. As for the acquired form, almost half of all known cases medical practice, is associated with complications that appeared after surgery. Acquired types also include fistulas that are created artificially. Such holes are made for the purpose of enteral nutrition, unloading of the organ during peritonitis, tumor formations, and intestinal obstruction.

By type, fistulas are divided into:

external;
internal;
mixed.

Internal fistulas connect the intestinal cavity with organs such as the uterus and bladder. They can also attach to other parts of the intestine. The external type is characterized by an opening on the surface of the skin. Fistula tracts mixed form have access to other organs and the skin. In addition, intestinal fistulas can be formed or unformed. The first option includes passages that have an opening into a wound of the abdominal wall or a purulent cavity, as well as those that do not have a fistulous passage due to the fact that they are attached to the intestinal mucosa and to the skin.

Formed type holes are characterized by the presence of a fistula tract, which is lined with tissue covering the surface of the body cavity. This type of fistula may have different passages, which differ in length, width and shape. Fistulas can also be single or multiple. Depending on the content, they are divided into complete and incomplete. In the first case, fluid leaves the intestine in such a way that it does not fill the efferent loop. With such fistulas, an intestinal spur is observed, which can be real or false. As for incomplete fistulas, with this pathology the contents of the organ do not come out completely.

Symptoms

Symptoms of intestinal fistula depend on their location, characteristics, and period of occurrence. The course of the disease with formed fistulas is considered milder. This species is not characterized by severe symptoms. With unformed fistulas, intoxication is observed, which is caused by inflammation in the area of the mouth of the fistula tract.

Photos of intestinal fistula can be easily found in specialized medical literature. In case of such a pathology, it is necessary to consult a doctor.

If we talk about internal interintestinal fistulas, they may not make themselves felt for a long period. Against the background of intestinal-uterine and intestinal-vesical fistulas, stool leaks through the vagina; it is also found in the urine at the time the bladder is emptied. With a fistula in the large intestine, the following symptoms are observed:

severe diarrhea;
significant weight loss.

External fistulas are characterized by certain clinical features, which depend on their location. With high intestinal fistulas, a defect appears on the skin through which yellow intestinal contents flow out, including gastrointestinal juices, bile, and food chyme. Dermatitis often develops around the cavity. Fluid loss through a high fistula of the small intestine leads to the development of MODS and a significant deterioration in the patient’s condition. He may lose 50% of his weight, and over time he will develop severe exhaustion and depression.

As for low fistulas that develop, they are not characterized by large volumes of fluid loss. If we take into account the fact that feces in this area have already been formed, the conclusion follows that a violation of the integrity of the epidermis and dermatitis will not develop. Common complications of fistulas in the intestinal area include water and electrolyte imbalance, bleeding, exhaustion, etc.

Diagnostics

If such a pathology is suspected, a visit to a gastroenterologist and surgeon will be required. Doctors will conduct a visual examination and palpation of the fistula. After the examination, the specialist will be able to confirm the presence or absence of a fistula tract and determine its shape. In the future, the patient will be prescribed other diagnostic measures. To find out where the pathological hole is located, fluid from the fistula tract is taken as material for analysis. This is done in order to identify bilirubin, bile acids, and enzymes produced by the pancreas.

In addition, tests are carried out with dyes. If there is a suspicion of a fistula of the small intestine, the patient takes methylene blue orally. If a fistula is detected in the large intestine, the drug is administered through an enema. Depending on the period of occurrence of the dye in the liquid released from the hole, its exact location is determined. To find out what condition they are in internal organs and whether they are associated with the fistula canal, the patient is prescribed an ultrasound of the abdominal organs, radiography and tomography of this area.

In addition, the doctor may decide to send the patient for irrigoscopy or fistulography, endoscopy. These diagnostic methods allow you to conduct a full examination of the internal mouth of the fistula, find out whether the intestinal mucosa is damaged and whether there is a true or false spur.

Treatment

Treatment of fistulas in the intestines is carried out in a hospital setting. If high small intestinal fistulas are detected, the patient is admitted to intensive care or to the surgery department. Patients who have asymptomatic colonic fistulas are referred to gastroenterology or prescribed therapy at home. On initial stage treatment, conservative manipulations are carried out, which involve replenishing the lack of fluid and normalizing the ion-electrolyte state.

When a wound with purulent contents, an abscess or dermatitis was discovered in the area of the fistula tract, the patient undergoes eradication of the area of infection and detoxification procedures. Local therapy is based on the use of bandages soaked in a hypertonic or enzyme solution. Ointments and pastes with an antiseptic effect are applied to pathological areas. The skin is also protected from fluid discharged from the intestines. The principle of physical protection is to create a barrier between the skin and organ secretions. For this purpose, paste, BF 1, BF 2 glue, and polymer films are used.

Biochemical protection consists of covering the mouth of the fistula tract with napkins soaked in milk, lactic acid or raw egg white. To carry out a mechanical blockade, devices are used in the form of an aspirator and an obturator, which prevents the intestinal contents from being released out. To neutralize the pancreatic and gastric juice, histamine receptor blockers and proteases may be involved.

At the time of conservative therapy, it is extremely important to adhere to certain rules nutrition. With the help of conservative treatment methods, the formed fistula heals after 1-2 months of regularly performing all procedures.

Surgical removal

Surgery for intestinal fistula is prescribed when therapy is ineffective. Surgical intervention is also used for fistulas of the descending branch of the duodenum, which is caused by failure of the biliodigestive anastomosis or injuries, which are characterized by a large loss of bile and intestinal contents.

TO surgical method Removal of labiform intestinal fistulas is resorted to in cases where they do not heal over a long period. For fistulas that are incompletely tubular or labiform, extraperitoneal methods of closure are appropriate. To eliminate all other types of fistulas, laparotomy is prescribed.

If labiform fistulas of the colon have been diagnosed, an operation may be prescribed, the method of which depends on the type of fistula (complete or incomplete). For incomplete labiform fistulas that have small sizes, resort to extra-abdominal options for their closure. This method involves isolating the intestinal wall in the area of the fistula and suturing the opening with a double-row suture.

For large incomplete and complete lip-shaped fistulas, the use of intra-abdominal removal methods is prescribed. To do this, the intestine is isolated along the entire perimeter of the pathological hole, it is removed into the wound and the fistula is sutured if it is incomplete. If the fistula is complete, an anastomosis is performed. If fistulas were found in large numbers, which are located on one intestinal loop, it is resected and anastomosis is performed.

Folk remedies

If a fistula of the small intestine has been detected, a folk remedy can be included in a comprehensive treatment regimen. They have a therapeutic effect and help eliminate inflammation. For rectal fistulas, you can use one of the following recipes:

Combine vodka and olive oil in equal proportions. Wipe the sore area with the composition several times a day. After the procedure, apply a cabbage leaf to the fistula.
Mix mumiyo and aloe leaf juice in a 1:1 ratio. Soak a bandage in the liquid and apply the bandage to the sore area.
Place 2 tbsp in a container. l. dry St. John's wort, pour 400 ml of water. Bring the mixture to a boil. Cool the resulting broth and then strain. Apply a bandage soaked in herbal infusion.
Take oak bark, water pepper grass, flax flowers in equal proportions, pour melted lard over the raw material and heat it up. In the composition moisten cotton swab and apply to the area with the fistula.

Prognosis and prevention

The fatal outcome after surgery for intestinal fistula is 2-10%. It all depends on the form of the fistula itself, as well as on the patient’s condition before surgery. Typically, deaths are associated with sepsis and renal failure. If the fistula tract is detected in time, through competent treatment it is possible to influence its spontaneous tightening. As for preventive measures, they consist of timely diagnosis and therapy background diseases, which entail the formation of fistula tracts.

Conclusion

It’s easier to get rid of a fistula early stages his appearance. Treating small intestinal fistula on your own is extremely dangerous, since this pathology can lead to serious consequences. To ensure a favorable outcome, it is extremely important to consult a doctor in a timely manner.