What Is a
A gastrointestinal fistula (GIF) is an abnormal opening in
your digestive tract that allows gastric fluids to seep through the lining of
your stomach or intestines. This can result in infection when it leaks into
your skin or other organs.
GIF most commonly occurs after intra-abdominal surgery,
which is surgery inside your abdomen. People with chronic digestive problems also
have a high risk of developing a fistula.
Types of GIFs
There are four main types of GIFs:
In an intestinal fistula, gastric fluid leaks from one part
of the intestine to the other where the folds touch. This is also known as a
This type of fistula occurs when gastric fluid leaks from
your intestine to your other organs, such as your bladder, lungs, or vascular
In an external fistula, gastric fluid leaks through the skin.
It’s also known as a “cutaneous fistula.”
A complex fistula is one that occurs in more than one organ.
of a GIF
There are several different causes of GIFs. They include:
About 85 to 90 percent
of GIFs develop after intra-abdominal surgery. You’re more likely to develop a
fistula if you have:
- radiation treatment to your abdomen
- a bowel obstruction
- surgical suture problems
- incision site problems
- an abscess
- an infection
- a hematoma, which is blood clot under your skin
- a tumor
Spontaneous GIF Formation
A GIF forms without a known cause in about 15 to 25 percent of
cases. This is also called a spontaneous formation.
Inflammatory bowel diseases, such as Crohn’s disease, can cause
GIFs. As many as 40 percent
of people with Crohn’s disease develop a fistula at some point in their lives.
Bowel infections, such as diverticulitis, and vascular insufficiency, or inadequate
blood flow, are other causes.
Physical trauma, such as gunshot or knife wounds that
penetrate the abdomen, can cause a GIF to develop. This is rare.
and Complications of a GIF
Your symptoms will be different depending on if you have an
internal or external fistula.
External fistulas cause discharge through the skin. They’re
accompanied by other symptoms, including:
- abdominal pain
- painful bowel obstruction
- elevated white blood cell count
People who have internal fistulas may experience:
- rectal bleeding
- a bloodstream infection or sepsis
- poor absorption of nutrients and weight loss
- 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.
to See the Doctor
Contact your doctor if you experience any of these symptoms
- a significant change in your bowel habits
- severe diarrhea
- fluid leakage from an opening in your abdomen or
near your anus
- abdominal pain
Your doctor will first review your medical and surgical
history and assess your current symptoms. They might run several blood tests to
help diagnose a GIF.
These blood tests will often assess your serum electrolytes
and nutritional status, which is a measure of your levels of albumin and
pre-albumin. These are both proteins that play an important role in wound
If the fistula is external, the discharge may be sent to a
laboratory for analysis. A fistulogram may be done by injecting contrast dye
into the opening in your skin and taking X-rays.
Finding internal fistulas can be more difficult. Your doctor
may run these tests:
- An upper and lower endoscopy involves the use of
a thin, flexible tube with a camera attached to view possible problems in your
digestive or gastrointestinal tract. The camera is called an endoscope.
- Upper and lower intestinal radiography with
contrast medium may be used. This can include a barium swallow if your doctor
thinks you might have a stomach or intestinal fistula. A barium enema may be
used if your doctor thinks you have a colon fistula.
- An ultrasound or CT scan can be used to find
intestinal fistula or abscessed areas.
- A fistulogram involves injecting a contrast dye
into the opening of your skin in an external fistula and then taking X-ray
For a fistula involving the major ducts of your liver or
pancreas, a special imaging test called a magnetic resonance
cholangiopancreatography (MRCP) may be used.
of a GIF
Your doctor will do a thorough assessment of your fistula to
determine the likelihood of it closing on its own.
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
Some types of fistulas close on their own when:
- your infection is controlled
- your body is absorbing enough nutrients
- your overall health is good
- only a small amount of gastric fluid is coming
through the opening
Your treatment will focus on keeping you well-nourished and
preventing wound infection if your doctor thinks your fistula may close on its
Treatments may include:
- replenishing your fluids
- correcting your blood serum electrolytes
- normalizing an acid and base imbalance
- reducing the fluid output from your fistula
- controlling infection and guarding against
- protecting your skin and providing ongoing wound
GIF treatment can take weeks or even months. Your doctor may
recommend surgically closing your fistula if you haven’t improved after three
to six months of treatment.
Fistulas close on their own about 25 percent of the
time without surgery in people who are otherwise healthy and when smaller
amounts of gastric fluid are being produced.
GIFs most often develop after abdominal surgery or as a
result of chronic digestive disorders. Talk to your doctor about your risks and
how to spot symptoms of a developing fistula.