SURGICAL DISEASES, TRAUMATOLOGY, ORTHOPEDICS, UROLOGY : FISTULA (FISTULAE) - etiology, pathogenesis, symptoms and course of, recognition, prediction and prevention
Fistulas may be congenital, often on the neck and in the umbilicus (irregularity development) and acquired as a result of damage (urine, bile, urine), inflammatory processes (pryamokishechnye ligature, when osteomyelitis and tuberculosis of the bones), when the collapse of the tumors. Fistula is a channel lined by granulation or, less commonly, epithelium; it connects the hollow bodies or opens on the surface of the skin or mucosa. Fistula can allocate pus, mucus or discharge of any authority (bile, urine). Fistulas are imposed artificially during the operation for temporary or permanent atbegshi urine and feces (urinary and fecal fistula).
Purulent and inflammatory process in the large-size cavity with a small exit hole and the absence of spadine it leads to the formation of the fistula with purulent discharge. Often purulent fistulas lead into the cavity formed around the foreign body (bullet, projectile, tampons, ligatures, splinters of bone, curtailment). Fistula with purulent discharge give the found out TB foci (bones and joints).
Etiology. Paraproctitis, later subjected to surgical treatment or revealed themselves in the rectum or around the anus.
The pathogenesis. Are distinguished: full fistula - a hole opens in the gut, the other out; the course is often complicated topography with extensions and thatcame in hand, covered with granulations, rarely epithelium; incomplete fistulas have one hole in the rectum (internal) or on the skin (external).
Etiology. Injury to the bowel during wounding and during surgery, paralysis of the intestine in the hernia incarceration, tuberculosis and actinomycetaceae defeat cancer, tumor lysis of the gut. Sometimes intestinal fistula impose during operation (more often on blind and S-shaped colon), intestinal obstruction, injury of the rectum, intestinal tumors.
The pathogenesis. There are external intestinal fistulas, when one end is opened to the outside, and the other in the cavity of the intestine, and inner - when the message has another intestine or hollow organ (bladder, stomach, and others). The fistula may be tubular and Goloviznin lined by granulation or covered with epithelium, an intermediate cavity.
Urinary fistulas are congenital defects of development of the bladder or urethra and acquired due to gunshot wounds, injuries, inflammation, malignant tumors, surgical interventions. You should also distinguish fistula connecting the urinary organs with the external environment through the skin, and fistulas, connecting them with other bodies (fistulas, mochetocnika-vaginal, vesical-vaginal, gallbladder and intestinal).
Arise as a result of the wounds of the bladder, inflammation in the surrounding tissue, in the female genital organs, prostate, malignant tumors that grow in the bladder and intestinal tract (gallbladder, intestinal fistulas). As a result of birth trauma, as well as gynecological operations are formed usernamelavinya fistula.
Meet in different parts of the anterior and posterior urethra. Cause is trauma, gunshot wounds and inflammatory processes.
Symptoms. Outward opening of the fistula with purulent discharge.
For. Fistulas or have no inclination to eliminate, or, their outer hole can be closed with subsequent exacerbation of the process, the formation of abscesses and secondary opening.
Symptoms. Permanent allocation of pus and mucus soiling linen, irritating the skin in the anal area, causing itching and eczema, sometimes pain when urinating and spontaneous emission. When viewed outside of the fistula visible small nipple skin, produce pus, sometimes with granulations. Internal fistulas are only visible when rectoscopy or when inspection of the rectum mirror. Palpation palpable thick cord running from the fistulous openings to the gut.
For. Fistulas have no tendency to heal. When narrowing of the external opening of the course exacerbation of the inflammatory process, resembling a paraproctitis, the fistula is opened sometimes in the same place, sometimes in the neighborhood.
Symptoms. The selection out of the intestinal contents, loss of mucosal ulcers, maceration of the skin in a circle. Symptoms of internal fistulas are less certain, different depending on the localization of the fistula. In the gastro-colic fistula is a pain in the epigastric region, flatulence, belching and vomiting fecal constipation, diarrhea emitting undigested food, emaciation.
Course and complications. Tubular fistulas can be cleaned up, especially when a long and narrow course. Spongy fistula inclinations to self-liquidation does not have. The higher the bowel fistula is and the more content is released through it out, the harder it is reflected on the General condition of the patient, causing exhaustion.
Renal fistula. The factors that impede the healing of these fistulas, education obstacles to the normal outflow of urine from the kidney, the presence of a foreign body (splinter of shell, stone), education Gorovenko fistula. Patients suffer from constant excretion of urine from the fistula, leading to skin irritation and unpleasant smell.
Most likely to occur due to surgical interventions (injured ureters) gynecological operations, at least in gunshot wounds. Cm. Diseases of female genital organs.
The main symptom of urinary incontinence. When the gallbladder-vaginal fistula urine is excreted from the vagina, when the gallbladder and intestinal fistulas she stands out with pieces of feces and gases and, on the contrary, faeces excreted urine. The symptoms of cystitis and proctitis.
Fistulas can be opened or wide Goloviznin hole, either in the form of narrow holes having a depth of winding turn. Urine is excreted from the fistula only during urination (unlike fistula to the bladder).
Should determine the direction and course of the fistula and the reasons supporting it. The x-ray region of the fistula and the surrounding bones and joints provides guidance on naschie or absence and the presence of foreign direct Fistulography indicates the direction and topography of the fistula.
Examination of razdevanie perianal folds can detect the external opening of the fistula. Introduction Pugacheva probe, methylene blue or other colors allows you to install the full fistula. Fistulography detail helps to find out the topography. For differentiation from tuberculosis helps history, General examination of the patient, the study of pus.
Detection is difficult when the internal fistula, when a clear picture often gives only x-ray examination. The height of the fistula is established by x-ray examination, and by inspection of the discharge and the time of occurrence of the fistula colored food.
From intestinal fistula distinguish unnatural anus (аnus praeternaturalis) when not part, but all of intestinal content comes out, not moving in the lower parts of the intestine.
The easy recognition on the basis of light - sewage holes in the lumbar region from which to extract the liquid with a smell of urine. The diagnosis is confirmed by the introduction of veins 5 ml of 0.4% Indigo Carmine, which stains blue color emitted from the fistula fluid. It is more difficult to establish the cause of hindering the healing of the fistula. Great help in the diagnosis has radiography (fistulography). By introducing into the fistulous orifice 25% solution of serrazina able to find out all the details (the course of the fistula, place barriers to the outflow of urine and position of a foreign body in relation to kidneys and fistula).
Recognition on the basis of these symptoms, cystoscopy (if it is possible) and radiography (fistulografii). In each case, it is important to find out the reason for the formation of the fistula and the cause it supports. So, fistulas often heal poorly because of the simultaneously existing urethral stricture or prostatic hypertrophy.
Recognition is easy.
Surgical removal of foreign bodies, the opening of the cavity, with the possibility of spadine during the healing process.
A systematic introduction to the fistula penicillin sometimes leads to the elimination of fistula, reduces inflammation and eases subsequent surgical treatment. Surgery is contraindicated in tuberculous fistula in advanced cases.
Treatment is conservative with tubular fistula; in other cases it is possible urgent operational. Skin irritation is eliminated by the open method of treatment baths and lubrication of the skin pastes and zinc oxide, the smooth skin of a 5% solution of potassium permanganate, the contraction of the fistula strips of adhesive tape and falling asleep wounds (if any fecal fistula) gypsum.
When a significant loss of parenchyma - nephrectomy. If the entire kidney saved catheterization of the ureter (coloured eliminate barriers to the outflow of urine), scraping with a sharp spoon fistulous openings and smearing it with silver nitrate. If conservative treatment remains unsuccessful surgical treatment.
Treatment is aimed at removing obstacles (stricture) to the outflow of urine bujirovanie and scraping fistula. When failure of the operation.