FISTULA

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It is an abnormal duct or passage resulting from injury, disease, or a congenital disorder that connects an abscess, cavity, or hollow organ to the body surface or to another hollow organ.

• Location of fistula
• Types of fistulas
• Cause
• Treatment

Location of fistula:

Fistulas or fistulae can develop in various parts of the body. Some are described below:-

1. Diseases of the eye, adnexa, ear, and mastoid process

• Lacrimal fistula 
• Mastoid fistula

• Cranio-sinus fistula: between the intracranial space and a paranasal sinus

• Labyrinthine fistula

• Peri-lymph fistula: tear between the membranes between the middle and inner ears

• Pre-auricular fistula

• Pre-auricular fistula: usually on the top of the cristae helicis ears

2. Diseases of the circulatory system

• Coronary arteriovenous fistula, acquired
• Arteriovenous fistula of pulmonary vessels

• Pulmonary arteriovenous fistula: between an artery and vein of the lungs, resulting in shunting of blood. This results in improperly oxygenated blood.

• Cerebral arteriovenous fistula, acquired
• Arteriovenous fistula, acquired

3. Diseases of the respiratory system

• Tracheoesophageal fistula following tracheostomy: between the breathing and the feeding tubes

4. Diseases of the digestive system

• Fistula of salivary gland
• Duodeno Biliary Fistula
• Fistula of stomach and duodenum
• Gastrocolic fistula
• Gastrojejunocolic fistula: after a Billroth II surgery, a fistula forms between the transverse colon and the upper jejunum (which, post Billroth II, is attached to the remainder of the stomach). Fecal matter passes improperly from the colon to the stomach and causes halitosis.

• Enterocutaneous fistula: the fistula between the intestine and the surface of the skin, namely from the duodenum, the jejunum or the ileum. This excludes the fistulas arising from the colon or appendix.
• Gastric fistula: from the stomach to the surface of the skin.

• Fistula of appendix
• Anal and rectal fistulae

• Anal fistula
• Ano-rectal fistula: This connects the rectum or other ano-rectal area to the surface of the skin. This results in abnormal discharge of feces through an opening other than the anus. It is also called fistula-in-ano.
• Fistula of intestine
• Enteroenteral fistula: between two parts of the intestine

• Fistula of gallbladder
• Fistula of bile duct
• Biliary fistula: connecting the bile ducts to the skin surface, often caused by gallbladder surgery
• Pancreatic fistula: between the pancreas and the exterior via the abdominal wall

5. Diseases of the musculoskeletal system and connective tissue

• Fistula of joint

6. Diseases of the urogenital system
7. Congenital malformations, deformations and chromosomal abnormalities

• Sinus, fistula and cyst of branchial cleft

• Congenital Preauricur fistula: A small pit in front of the ear. Also called Fistula Auris Congenita or Ear Pit

• Congenital absence, atresia and stenosis of rectum with fistula
• Congenital absence, atresia and stenosis of anus with fistula
• Congenital fistula of rectum and anus
• Congenital fistulae between uterus and digestive and urinary tracts
• Congenital rectovaginal fistula

8. External causes

• Traumatic arteriovenous fistula
• Persistent postoperative fistula

Types of fistulas

Various types of fistulas include:-

1. Blind: with only one open end
2. Complete: with both external and internal openings
3. Incomplete: a fistula with an external skin opening, which does not connect to any internal organ

Most fistulae are in the form of a tube but some can also have multiple branches.

Cause:

1. Diseases- some diseases like Crohn's disease and Ulcerative colitis are responsible for the development of fistulae.
2. Trauma- injury, obstetric fistula etc.
3. Medical treatment- constant radiological exposure leading to development of a fistula or fistulae

Treatment:

1. Homeopathy -  The patients of fistula are usually advised surgery for their problem but this is just a temporary solution as invariably the fistula/fistulae recur. A lot of complications can also occur due to surgery. Homoeopathy helps in treating complications and preventing the recurrence. The medicines are selected based on the case analysis and individualizing the case. A good Homeopathic doctor can heal all the symptoms associated with it, even without surgery.
2. In severe cases, surgery is advisable to the patient along with the Homeopathic remedies.

Please E-mail dr_ramanand@rediffmail.com for any questions/treatment