Fistulas are common in Crohn's disease, but they do not occur in ulcerative colitis.

Symptoms and Complications

The symptoms can vary a lot according to each individual and the severity of the fistula Location plays a big part in how you feel too. Some cause no discomfort; others, may cause only intermittent
symptoms. However, some fistulas can have serious complications. They
may become lined with tissue from the epithelium (the lining of the intestine) and allow the contents of your bowel to pass from one organ to the other (e.g., from the bowel to the bladder).

Additional problems happen when a fistula becomes infected, and an abscess (a pocket of infection) is formed, or when the fistula closes and an abscess forms. If this happens, the patient experiences pain, fever, and localized tenderness. But, if recognised quickly, such complications can be treated effectively by the doctor.

Types of Fistulas

Most commonly, fistulas affect the the area around the anus and genitals. Types of fistulas include:

Enteroenteric or Enterocolic--fistulas to the small intestine or
the colon.

Enterovesicular--a fistula to the bladder. Frequent urinary tract infections are a sign that this type of fistula may be present. It may also cause pneumaturia (the passage of gas or air from the
urethra during or after urination).

Enterovaginal--a fistula to the vagina.

Enterocutaneous--a fistula to the skin. It sometimes occurs after surgery, creating a channel that passes from the gut through the wound, and into the skin.

Diagnosis

Various diagnostic tests, which are often used in IBD, can reveal the presence of a fistula. The type of exam required depends on the location of the fistula.

barium meals/enema (done in the X-ray dept.)

; endoscopic exams eg. A sigmoidoscopy/colonoscopy

A special type of x-ray exam, known as a fistulogram, enables doctors to track the fistula in your body

an intravenous pyleogram (IVP- a type of x-ray exam), can reveal the presence of a fistula to the urinary tract.

Treatment

Treatment is entirely specific to you and your case, and depends on what kind of fistula you have. This may include:Letting the fistula be if you have no pain from it
Antibiotics to improve and heal it
A special liquid diet to rest your bowel and let it heal .Surgery in the most extreme cases where the fistula hasn't
responded to the above methods. The diseased section is taken away and the good bits are sewn back together. This is called a resection.

Sometimes the resection is followed by a temporary ileostomy. The ileostomy diverts the intestinal contents away from the fistula, protecting the anastomosis (the surgical connection of the remaining
intestine) and allowing it to heal. The good news is that with good aftercare and evaluation, very few people have medical complications after this procedure.

Treatment of fistulas really goes on your as a person. Crohn's is a very individual disease, and your treatment will be specific to you.

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on September 21 2002 01:00:32 ·