What symptoms can occur?
The symptoms of a fistula vary greatly. They depend on the situation, location and extent of the fistula. In many cases, they can cause pain, especially if they are superficial.
An unnatural opening of two adjacent organs can lead to various symptoms and clinical pictures. Blood, pus or any kind of fluids such as stool, urine or bile can be secreted through the fistula. The superficial fistulas can cause local pain and discomfort.
Fluid may leak to the outside. On the other hand, they can easily lead to local inflammation, which can also be painful and can cause complications. The symptoms vary greatly depending on the organ area affected. A rare form of fistula is the “aortoenteral fistula”, which connects the aorta with the bowel and can cause acutely life-threatening bleeding into the bowel. Such a fistula is difficult to treat and has a very poor prognosis.
What are fistula tracts?
If there is a connection between different hollow organs or between a hollow organ and the body surface which is unnatural, it is called fistula tract. The cause for the development of a fistula tract is usually an encapsulated inflammation of an organ. The resulting abscess then favors the formation of the fistula tract, which is intended to transport the pus out of the organ.
On the other hand, fistulas can also be congenital or can be artificially created by a doctor for the treatment of various diseases. Congenital fistula ducts are persistent fistulas that should originally have closed before birth. The Urachus fistula, i.e. the connection between the bladder and the navel, is an example of this. An example of an artificially created fistula tract is the external stomach fistula. The doctor creates this in order to artificially feed the patient during an operation.
Where are there fistulas everywhere?
Fistulas develop from different causes in body parts with cavities.In rare cases, they can occur between two vessels, for example in arteriovenous fistula. In this case, blood exchange occurs between the two vessels. The symptoms are quite different.
Typical localizations of fistulas are, for example, between the intestine and the bladder (“enterovesical”), bladder and vagina (“vesicovaginal”), urethra and vagina (“urethrovaginal”), esophagus and trachea (“oesophagotracheal”) or rectum and vagina (“rectovaginal”). Fistulas can also occur on the teeth or gums. The occurrence of fistulas is not limited to the hollow organs listed here, but can theoretically occur on all hollow organs.
Fistulas can also exist between organ areas or cavities and the skin. The cavities then have a non-natural exit to the body surface. This occurs, among other things, in the intestine (“enterocutaneous fistula”), which can be caused by inflammation or is artificially created.
A congenital or acquired hole in the skin at the coccyx (coccyx fistula) is also called a fistula or “sinus pilonidalis”. Fistulas in the mouth are not rare and can be very painful. Very common is fistula formation at the root of the tooth as a result of inflammation.
The fistula can occur anywhere in the mouth, on the lip, palate, gums (fistula on the gum) under the tongue or in the throat. Other fistula formations in the mouth area are very rare. In the throat, however, various types of fistulas can occur, which often have their cause in an embryonic malposition.
Fistulas below the tongue are very rare. In fact, aphthae often develop on the tongue, which can burn and cause pain. This is a damaged area of the mucous membrane of the tongue.
The most common places for aphthae of the tongue are the edge and tip of the tongue. Rarely, aphthae are located on the underside of the tongue. The cause for the development of these aphthae is still unknown.
Very very rarely, an inflammation of the root of the tooth can lead to the formation of fistulas up to the underside of the tongue. Also in the oral cavity, fistula formation can occur on the tooth in the context of inflammatory diseases. Especially at the root of the tooth they can develop preferentially.
An inflammation of the tooth root is in many cases the cause. Such an inflammation can have many different causes, but the patient is not always directly to blame. Lack of oral hygiene, unhealthy diet or chronic diseases can be the problem.
The inflammatory reaction of the body can then in unfavorable cases lead to dental root inflammation, which must be treated urgently. Many try to bear the pain until it disappears. Untreated, however, the root of the tooth can die.
The accumulated pus sometimes causes severe pain and makes its way into the oral cavity. This leads to fistula formation. The pain then often stops quite suddenly, which is a bad sign in this case.
However, the cause of the inflammation must be treated, even though the pain has disappeared. Fistulas can also occur in the mouth area of children, which is why adequate oral hygiene must always be ensured. Regular visits to the dentist, especially when pain is present, are important.
A neck fistula is a tubular connection between the inner throat and an opening in the neck. The reason for this is a disorder during embryonic development. In the womb, there is a passage in the neck area between the original thyroid gland, which is at the base of the tongue, and the final position of the thyroid gland.
Normally, this so-called ductus thyreoglossus recedes during embryonic development. If this does not happen, the anterior (medial) neck fistula is formed. The neck fistula can be recognized by a painless swelling of the neck.
If it becomes inflamed, it can cause pain, hardening or an encapsulated purulent accumulation (an abscess) under the skin. A fistula of the anus is also called an anal fistula and is a very common problem. Its symptoms range from itching and pain to secretion on the skin surface.
However, the symptoms depend on the direction in which the fistula spreads. Congenital anal fistulas are very rare. Although the coccyx fistula is located on the skin surface around the buttocks, it rarely has contact with the anus.
A fistula on the anus is in most cases the result of an inflammation in this area of the intestine. Often glands are affected which are located in the mucous membrane of the anus and can become inflamed.During the inflammation, purulent secretion is secreted, which can form an abscess (abscess on the buttocks) and causes fistula formation if it has no opening to drain off. Other intestinal diseases that come into question are “Crohn’s disease“, “ulcerative colitis” or “diverticulitis“.
The direction in which the fistula spreads can be different. If the fistula develops in the direction of the back, it can reach the surface of the skin and break through it. Then there is a second intestinal outlet, through which pus mainly flows out.
If the fistula is directed in the opposite direction, a rectovaginal fistula may occur. This is often noticed by vaginal discharge of pus and stool. Otherwise, the fistula often ends up blind in the tissue.
In rare cases, anal fistulas can also develop in other ways. Possible are tears in the anus, so-called “anal fissures”, but also tumor diseases or HIV infections. Fistulas can also occur on the navel.
These are also called “navel fistula” or “yolk fistula”. A distinction must be made between an umbilical cord hernia (“omphalocele”), an urrachus fistula and an umbilical fistula. All three are in most cases a remnant from embryonic development.
The umbilical fistula goes back to a structure of the embryo, the so-called “yolk duct” or “Ductus omphaloentericus”. During child development, it connects the yolk duct with the developing child’s intestine. The yolk duct opens at the navel and if it remains until after birth, it forms a fistula between the intestine and the navel.
If this duct is open, the typical symptoms of a navel fistula occur. Through the navel, stool, bile, mucus and other intestinal contents can be conducted to the outside. On the other hand, pathogens can penetrate unhindered from the outside into the inside of the body and cause diseases or infections.
The navel fistula should therefore be treated to prevent unpleasant inflammations. Fistulas can form in many parts of the intestine. The entire gastrointestinal tract extends from the oral cavity to the anus.
Fistulas can already develop in the oral cavity. Also at the esophagus, developmental fistula can lead to trachea. In the course of the small and large intestine there are many places for potential fistula formation.
Only a few of these are congenital. One example is the navel fistula, which is a relic of the embryonic period. Most intestinal fistulas develop as a result of inflammatory bowel diseases.
The typical diseases that cause pus production with resulting fistula formation are Crohn’s disease, ulcerative colitis and diverticulitis. > Depending on the direction in which the fistula formation spreads, very different clinical pictures occur. Connections to the skin (enterocutaneous fistulas), connections to other parts of the intestine (interenteric fistulas) or connections to other organs such as the vagina (rectovaginal fistulas) may develop.
Under certain circumstances, fistulas of the intestine may also occur, intentionally or unintentionally, as a result of surgical procedures. A coccyx fistula (sinus pilonidalis) is caused by inflammation of the subcutaneous fatty tissue in the coccyx region, most frequently in the gluteal fold. This occurs – as is assumed today – when hair breaks off in this region and grows into the skin.
This results in a hair nest pit in the subcutaneous fatty tissue. The widened hair shaft causes black depressions on the skin surface. If these hair nest pits under the skin become inflamed, an abscess can develop.
This can result in fistula ducts that grow even deeper into the tissue or extend towards the skin surface. Risk factors that favor the development of a coccyx fistula are: heavy hairiness obesity sedentary activities The course of the disease can take three different paths: In the asymptomatic form, patients usually have no symptoms. Only the black depressions in the gluteal fold are visible.
However, the asymptomatic form can also change into an acute or chronic form. The acute form is characterized by inflammation of the hair nest pit. Here, typical signs of inflammation occur: swelling, redness and pain.
The chronic form leads to the discharge of pus or blood from the fistula opening, especially when there is pressure on the corresponding region of the fistula opening.
- Strong hairiness
- Obesity
- Sitting activities
An arteriovenous fistula is a so-called short circuit between an artery and a vein. This short-circuit connection can be congenital or can be caused by various diseases in the course of life.
However, acquired ones are much more common, e.g. these AV fistulas are caused by injuries to the corresponding artery and the vein in its immediate vicinity. In the course of dialysis treatment, even an AV fistula is intentionally created in order to reduce the probability of a clot forming in the affected vein due to the faster blood flow. The symptoms vary: Congenital superficial fistulas can swell and then look reddish-brown.
An acquired AV fistula can lead to low blood pressure if left untreated, which can cause fatigue or dizziness. This is because the short-circuit connection causes high blood pressure in the vein due to the faster blood flow. High blood pressure causes the walls of the veins to dilate, which in turn causes the blood pressure to drop.
The heart must counteract this low blood pressure, which is why the heart rate and stroke volume increase. If the heart is overtaxed, heart failure can occur. The so-called steal syndrome or tapping phenomenon occurs when the AV fistula “drains” so much blood that symptoms such as numbness, cramps, and pain develop.
