Introduction
Fistulas are pathological, tubular-shaped routes that are created between one organ and another or between an internal cavity and the skin. In other words, the fistula (never present in physiological conditions) is an anomalous canaliculus that connects two neighboring and normally separate anatomical structures. The causes of origin are to be found mainly in abscesses, severe inflammations and infections; less often, these particular ways of communication are purposely created by the surgeon for various therapeutic purposes.
To understand: how and why pathological fistulas are formed
Severe inflammation of an organ → abscess formation (purulent infection) that crosses the surrounding tissues → burst of the abscess → pus leakage → formation of the tubular duct (fistula) that connects the inflammatory focus with the neighboring organs
Symptoms
Rectal VAGINAL FISTULES can cause malodorous vaginal secretions, recurrent urinary / vaginal tract infections and pain during intercourse (dyspareunia).
Some FISTULAS of the DIGESTIVE APPARATUS can even provoke a very strong and unpleasant halitosis: it is the case of the fistulas that are created between the transverse colon and the upper jejunum: in these cases, the fecal material tends to pass from the colon to the stomach, thus procuring breath bad.
Not even DENTAL FISTULAS go unnoticed: persistent toothache is in fact one of the characteristic symptoms of dental fistula, expression of complicated caries, pulpits, gangrene, alveolar abscesses or cysts at the root of the tooth.
Complications
It is not uncommon for substances that are deposited in fistulas (such as urine, faeces, pus, saliva, blood, etc.) to further infect the affected site, creating greater damage that can be exaggeratedly expanded. It should not be forgotten that an untreated fistula can become chronic to the point of degenerating into gangrene.
Therapy
Given that the treatment for fistulas is mainly linked to the cause and the severity of the damage, it is necessary to highlight that these lesions always have a very low tendency to spontaneous healing. In fact, to eliminate a fistula it is often necessary to undergo a double treatment consisting of a surgical procedure (called fistulectomy ), and a powerful prophylactic antibiotic therapy.
Before undergoing surgery, the patient is usually subjected to a specific radiological investigation to ascertain the direction, depth, length and precise position of the fistula. This examination, called fistulography, consists of the injection of a special radiopaque contrast liquid directly into the fistula channel.
Surgery undoubtedly proves to be the solution of first choice for draining the lesion: in this way, it helps to release the pus that has accumulated along the fistula, while preventing an abscess from forming (or reforming).
Unfortunately it is not uncommon for more fistulas to be removed and cleaned thoroughly: in fact, often, the fistula reappears after a more or less long period of time due to incomplete or incorrect cleaning. To reduce the risk of recurrence, many surgeons, at the time of the operation, use the so-called "seton": it is a special thread that is made to slide along the entire path of the fistula in order to better clean the pathological tract .
Did you know that ...
When the fistula is simply eliminated without acting on the cause that caused it, in all probability, the fistula tends to recur. To give an example, the surgical elimination of a fistula in the context of Crohn's disease can be effective in an early period, but if it does not directly address the triggering disease with adequate treatment, the fistula tends to recur in 50% of the interventions .
Post intervention
After the fistulectomy, the patient will have to observe a period of absolute rest.
The period of convalescence varies not only from patient to patient, but also in relation to the extension of the surgical wound, the location of the fistula and the severity of the damage.
As for the interventions at external fistulas - which therefore connect an internal cavity with the skin - the patient's convalescence could be rather annoying. To buffer the pain and discomfort caused by the operation, the patient can take pain-relieving drugs and make compresses with warm water several times a day.
Cleaning must also be scrupulous: to prevent the surgical wound from becoming infected again, it is essential for the patient to keep the lesion clean and sanitized.
After the removal of the fistula, work and sport activities can be resumed when the patient is able to move freely and easily without feeling any pain.
The implementation of the doctor's advice and the respect of rest minimize the post-intervention risks, at the same time reducing the possibility that the fistula may recur or become chronic.
