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Overview of enteric fistulas

Sharon L Stein, MD, FACS, FASCRS
Section Editors
Eileen M Bulger, MD, FACS
J Thomas Lamont, MD
David I Soybel, MD
Deputy Editor
Wenliang Chen, MD, PhD


A fistula is an abnormal connection between two organs. Enteric fistulas are abnormal connections between the gastrointestinal tract and other abdominal organs, chest, or skin. Symptoms associated with fistulas depend on whether the fistula is proximal (eg, stomach, jejunum) or distal (eg, ileum, colon) and may include diarrhea for entero-colonic or enteroenteric fistulas; urinary tract infections for fistulas to the urinary system; or external drainage of enteric contents for enterocutaneous or entero-atmospheric fistulas.

The treatment of fistulas requires optimization of nutrition and healing potential, and definitive surgical treatment, when indicated. Many enteric fistulas may heal spontaneously. Nonoperative interventions such as endoscopic or interventional radiology can be used for temporary or definitive management of fistulas. During evaluation, a thorough consideration of the etiology of the fistula, removal of precipitating factors, optimization of nutritional status, and primary treatment of fistulas should occur. Up to 25 percent of mortality from fistulas occurs as a result of infection and sepsis related to complications from fistulas. Additional mortality is often due to fluid and nutritional losses secondary to uncontrolled fistula output. Immediate surgery may be required in the setting of uncontrolled sepsis.

An overview of the clinical features, diagnosis and management of enteric fistulas is reviewed here. Other enteric fistulas, including pancreatic fistulas, are introduced briefly below, but reviewed in more detail in separate topic reviews. (See "Pancreatic fistulas: Clinical manifestations and diagnosis" and "Pancreatic fistulas: Management" and "Urogenital tract fistulas in women" and "Rectovaginal and anovaginal fistulas" and "Anorectal fistula: Clinical manifestations, diagnosis, and management principles".)


A fistula is an abnormal communication between two structures.

Enteric fistulas can be classified as internal or external depending upon whether they drain externally to the skin or internally to the gastrointestinal tract or other organ (eg, bladder, vagina). Enteric fistulas are also classified with respect to the anatomic segments of bowel (ie, other organs or vascular structures) that are involved [1].

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Literature review current through: Nov 2017. | This topic last updated: Mar 20, 2017.
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