A fistula is an abnormal, tunnel-like connection that forms between two organs, two vessels, or between an internal structure and the skin. These passages are not supposed to exist and often develop due to injury, inflammation from diseases like Crohn’s, or as a complication of surgery. While fistulas are treatable with medical intervention, the answer to whether they are dangerous is a clear yes; if left unaddressed, they pose serious, life-threatening health risks that require immediate medical attention.
Defining the Danger: Why Fistulas Require Immediate Attention
The primary danger associated with a fistula stems from the misdirection of bodily contents into areas of the body that cannot handle them. When digestive enzymes, urine, or infectious material travel through the abnormal tract, they cause significant irritation and inflammation in surrounding tissues. This misplaced flow often leads to the formation of localized infections and abscesses, which are pockets of pus that can grow rapidly and cause intense pain and tissue destruction.
An untreated localized infection can quickly become a systemic threat, potentially escalating into sepsis, a life-threatening condition where the body’s response to infection damages its own tissues and organs. For gastrointestinal fistulas, such as those connecting the intestine to the skin (enterocutaneous fistulas), infectious material like stool can enter the abdominal cavity or bloodstream.
Fistulas that involve the digestive tract also cause severe nutritional and metabolic consequences. When a portion of the small or large intestine is bypassed by a fistula, the body loses the ability to absorb necessary nutrients, fluids, and electrolytes. This continuous loss of contents leads to rapid malnutrition, severe dehydration, and critical electrolyte imbalances that impair organ function.
The constant exposure of the skin to digestive enzymes, especially from high-output fistulas, results in chronic irritation, skin breakdown, and damage to the surrounding tissue. This further complicates wound care and increases the risk of secondary infections.
Anatomy of a Fistula: Classifying the Different Types
Fistulas are broadly classified by the two points they connect, illustrating the varied immediate risks they carry. For instance, perianal or anal fistulas connect the anal canal to the skin near the anus, typically arising from an abscess that failed to heal completely. The primary risk here is chronic infection, recurrent abscesses, and potential damage to the sphincter muscles, which can result in fecal incontinence.
Gastrointestinal fistulas involve the digestive tract and can be classified based on their endpoints. An enteroenteric fistula connects two different segments of the intestine, allowing contents to bypass a section of the bowel and potentially leading to malabsorption. An enterocutaneous fistula creates a path from the gut to the skin, causing external leakage and significant fluid loss.
Fistulas involving the genitourinary system present a contamination risk specific to their location. A vesicovaginal fistula connects the bladder and the vagina, resulting in the continuous leakage of urine through the vagina. Similarly, a rectovaginal fistula connects the rectum and the vagina, causing gas or stool to pass through the vagina. These types of fistulas create profound issues with hygiene, cause severe local irritation, and increase the risk of ascending urinary tract or pelvic infections due to the presence of misplaced waste products.
Mitigating Risk: Treatment and Management
The initial focus of management is on controlling infection and stabilizing the patient’s nutritional status. This non-surgical phase involves the aggressive drainage of any surrounding abscesses to control localized infection and the administration of broad-spectrum antibiotics to address systemic spread.
Specialized nutritional support is paramount, especially for gastrointestinal fistulas, where the gut is often “rested” to reduce output and facilitate potential spontaneous closure. This often means providing nutrients intravenously through total parenteral nutrition (TPN) to correct malnutrition and fluid or electrolyte imbalances. For some fistulas, specialized wound care and temporary sealing techniques, such as the injection of fibrin glue or the placement of a draining seton thread, may be used to manage output and prepare the area for definitive repair.
While conservative measures can stabilize a patient, surgical repair is frequently required for the complete and lasting elimination of the abnormal tract. Surgical options range from a simple fistulotomy, which opens the entire tract to allow it to heal from the inside out, to more complex procedures like the Ligation of the Intersphincteric Fistula Tract (LIFT). The specific surgical method chosen depends on the fistula’s location and complexity, aiming to close the abnormal connection permanently while preserving the function of surrounding structures, such as the anal sphincter muscles or urinary tract.