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View Full Version : FAECAL FISTULA(Etiology-Pathology-Clinical picture-Investigations-Treatment)



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05-03-2008, 05:23 AM
m Causes:
1- Congenital: Persistance of vitillo-intestinal duct.
2- Post operative: The commonest cause e.g. After appendicectomy due to ® gangrenous appendix, misdiagnosis, appendicular mass or neglected drains.
3- Inflammatory:· T.B. (The 2nd common) · Crohn's diseas
Direct fist.



indirect fist.

· Ulcerative colitis, diverticulitis
· Bilharzial pericolic absces.
4- Neoplastic: · Cancer colon rarely cause fistula
m Pathological Types:
1- Direct fistula: with short track
* Mucous lined “never close” * Granular lined “may close”
2- Indirect fistula: with long track may be partially epithelialized.
m Diagnosis:
I) Fistula or not: (may be abscess discharging faeculent pus).
1- Charcoal test:
The patient takes tablets by mouth if it gives black discoloration of discharge
\It is faecal fistula and not an abscess with faeculent pus.
2- Fistulogram:
Lipiodol injection from the external opening, it shows length, direction & level of fistula.
II) Level of the fistula:
1- High fistula e.g. jejunal fistula.
* bile stained fluid discharge * increase enzyme content
* maceration * severe dehydration.
2- Low fistula: Semisolid faecal discharge. No enzyme; No maceration.
m Treatment:
1- Conservative treatment:
- Indications ®direct granular type or colonic fistula.
- Medications;
a- Nothing by mouth, I. V. fluid, Constipating mixture.
b- Intestinal antiseptic e.g. Neomycin
c- Protect skin from proteolytic enzymes by vaseline or zinc oxide ointment.

2- Surgical treatment:
· Indications: Failure of medical treatment as occured in high fistula, Mucous lined, and Partially epithelialized type.
· Operation: Excision of the fistula with related segment of the gut then anastomosis.
SOURCE: DR. AYMAN SALEM'S BOOK
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