Small Bowel Fistula Management
A small bowel fistula occurs when epithelial tissue from the outer lining of the intestine attaches and connects to another organ, inside of the skin, or another part of the intestines. Although large bowel or colon fistulas are more common, small bowel fistulas do occur especially after abdominal surgery. An enterocutaneous fistuala is one that connects the intestine and the skin. About 80% of this kind of fistula is the result of abdominal surgery. The remainder is caused by inflammation, irradiation, or tumors. About a week after surgery, the patient develops a fever and an abscess at the surgical site. The wound is drained and the fever goes away. About 24 hours later the contents of the bowel begin to appear on the dressing of the wound.
Intestinal fistulas may also attach to the bladder, anus and vagina. If a blood vessel in the small bowel fistula ruptures, then the patient will have bloody bowel movements. If a small bowel fistula that is attached to another part of the intestine fills up but is unable to empty, the result is a bowel obstruction. Symptoms of bowel obstruction include abdominal pain and cramping, vomiting, bloating, constipation or diarrhea. An obstructed small bowel fistula will cause pain around the belly button area, while one in the large intestine or colon will cause pain lower in the abdomen.
The right choice for fistula treatment depends on many different factors, including the location and type of fistula. If the patient has no symptoms, no treatment is usually needed. Fistulas may respond to immunosuppressive medications, antibiotics, or both. Patients also need to have their nutritional health monitored because they can easily become malnourished. Fistulas are typically slow to heal. They often come back in 6 months or so. If the less invasive treatments fail to resolve the problem, then surgery is indicated.