The doctor first reviews the medical and surgical history and assesses the current symptoms. Several blood tests may be prescribed to help identify a Gastrointestinal Fistula.
The blood tests are to assess serum electrolytes and nutritional status. They measure the levels of albumin and pre-albumin. These two proteins play an important role in wound healing.
In the case of an external fistula, the discharge is sent to a laboratory for analysis. Further fistulogram may be performed to evaluate the fistula formed.
This is done by injecting contrast dye in to the opening in your skin and taking X-ray images. Internal fistulas are difficult to diagnose. The doctor may run the following diagnostic procedures to ascertain an internal fistula:
- An upper and lower endoscopy: It involves the usage of a thin, flexible tube with an attached camera. This is to evaluate visually by taking images of the digestive system for the formation of internal fistulas.
- Upper and lower intestinal radiography with contrast medium: A barium swallow may be considered if the doctor predicts a stomach or intestinal fistula. Besides, a barium enema may be used should the doctor expect a colon fistula.
- An ultrasound or CT scan.
- Magnetic resonance cholangiopancreatography (MRCP): It is a special imaging technique should the preliminary evaluation of the doctor suggest a fistula formation in the major ducts of the liver or pancreas.
There are four main types of Gastrointestinal Fistulas:
Intestinal fistula: Also known as a "gut-to-gut" fistula. An abnormal opening is formed between the folds of the intestine and the gastric fluid from one part of the intestine seeps into another.
Extraintestinal fistula: The fistula gets formed with other surrounding organs, such as the bladder, vascular system (blood vessels), or lungs. Thus, allowing the gastric fluid to leak into these organs.
External fistula: Also called the "cutaneous fistula" the gastric fluid seeps into the skin.
Complex fistula: It is a fistula that occurs and impacts more organs by the leakage of gastric fluids.
After a thorough evaluation of the fistula, the doctor will comment if the fistula is capable of healing on its own. This is decided by the volume of fluid that seeps through the fistula per day.
It can range from low output fistulas that leak 200 milliliters (mL) of gastric fluid to high output fistulas that leak about 500 mL per day.
Depending on the type of fistula, the doctor may consider a treatment regimen that allows the fistula to heal by itself.
Gastrointestinal Fistula treatment can take weeks or even months to self-heal. The doctor may recommend closing the fistula surgically only if the condition of the patient does not improve after three to six months of treatment.
Traditional Open Surgery
If a patient has sepsis then the doctor will recommend or immediate surgery. The surgery will involve the fistula draining.
The negative pressure therapy makes sure of vacuum to increase the blood flow to a certain area to assist in draining the excess fluid.
Endoscopy Treatment
The doctor might also use endoscopic techniques to drain the fluid. The endoscope is passed through the rectum and into the abdominal area.
The leaking areas of the fistula are further sealed with glue or clips. The drawback of endoscopy is, even if it is a less invasive technique, it is not practically possible to reach all the fistulas through it.
A GIF can occur due to many conditions that favor its formation:
Spontaneous GIF:
In about 15-20 percent of the cases, a GIF is formed without a known factor.
An approximate 40 percent of the patients suffering from Crohn's disease are known to develop a GIF at some point in their condition. Crohn's disease is categorized under Inflammatory Bowel Diseases (IBD).
Surgery related complication:
An intra-abdominal surgery in about 85-90 percent of the cases is known to cause a GIF formation after the surgery. Factors responsible for such kind of surgery could be:
- Malnutrition
- Infection
- Bowel obstruction
- A blood clot under the skin (hematoma)
- Abscess
- Tumour
- Cancer
The problem arising from the incision site (Surgery related complications):
- Improper surgical suturing
- Radiation treatment to the abdominal region
- The symptoms are dependent on the site where the fistula has formed.
- Individuals who have developed internal fistulas may show the following symptoms:
- Diarrhea
- Dehydration
- Poor absorption of the food consumed and weight loss
- Sepsis (infection in the blood)
- Rectal bleeding
Sepsis
It is a symptom that needs immediate medical attention and care. It is a severe response of the body to bacterial exposure.
It should be considered as a medical emergency, because if unattended, the condition may lead to extremely low blood pressure, damage to the organs, and even death.
External fistulas
It results in discharge through the skin, pose the following symptoms:
- Fever
- Hike in the white blood cell (WBC) count
- Painful bowel obstruction
- Pain in the abdomen
Any of the symptoms should be met with immediate evaluation of a medical professional to avoid further complications of the condition
The complications of a fistula may lead to obstruction of the bowels, incontinence (patient losing control of the bowels), low blood pressure, and reoccurrence of the fistula at some other location.
As the severity increases, it may lead to sepsis (the most common), damage to the other organs involved, and ultimately death if left untreated.
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