What causes a fistula. What is a fistula after surgery, what does it look like? Ligature fistula of a postoperative scar, fistula at the seam after childbirth, cesarean, appendicitis: signs, causes, treatment, excision

A fistula after surgery is always postoperative complication. The fistula occurs as a result of suppuration, infiltration of the scar. Consider the main causes of fistula, its manifestations, complications and methods of treatment.

What is a fistula

A ligature is a thread used to tie blood vessels during surgery. Some patients are surprised by the name of the disease: they think that the wound after the operation can whistle. In fact, the fistula occurs due to suppuration of the thread. Ligature suture is always necessary, without it, wound healing and stopping of bleeding, which always occurs as a result of surgical intervention, cannot occur. Without a surgical thread, it is impossible to achieve wound healing.

Ligature fistula- this is the most frequent complication after operation. Looks like a normal wound. It refers to the inflammatory process that develops at the site of the seam. An obligatory factor in the development of a fistula is suppuration of the suture as a result of contamination of the thread by pathogenic bacteria. A granuloma appears around such a place, that is, a seal. As part of the compaction, the festering thread itself, damaged cells, macrophages, fibroblasts, fibrous fragments, plasma cells, collagen fibers are found. The progressive development of suppuration eventually leads to the development of an abscess.

Reasons for the formation

As already mentioned, it is the festering suture that contributes to the progression purulent process. A fistula always forms where there is a surgical thread. As a rule, the recognition of such a disease is not difficult.

Often fistulas result from the use of silk thread. main reason such a phenomenon is the infection of the thread with bacteria. Sometimes he doesn't have large sizes and it goes by quickly. Sometimes a fistula occurs a few months after the intervention. In rare cases, the fistula appeared even after years. Most often they occur after operations on the abdominal organs. If in place operating wound a fistula occurs, this indicates that an inflammatory process is taking place in the body.

If during the operation a foreign body enters the body, it causes infection of the wound. The reason for this inflammation is a violation of the processes of removing purulent contents from the fistulous canal due to a large amount of fluid. If in open wound an infection gets in, this can be an additional danger, as it contributes to the formation of a fistula.

When a foreign body enters the human body, weakening begins immune system. Thus, the body resists viruses longer. Prolonged presence of a foreign body and causes suppuration and subsequent release of pus from postoperative cavity out. Infection of the ligature thread often contributes to the formation of a large amount of pus in the postoperative cavity.

Main symptoms

The fistula at the seam has such pronounced symptoms:

Diagnosis and treatment

The correct diagnosis can be made by the surgeon only after complete diagnosis. It includes such measures:

1. Primary medical examination. During such actions, the fistula canal is assessed, the granulomatous formation is palpated.
2. Study of patient complaints. There is a careful study of the medical history.
3. Sounding the channel (to assess its size and depth).
4. Examination of the fistula channel using X-ray, ultrasound, dyes.

All patients should remember that the treatment of fistula with folk remedies is strictly prohibited. It is not only useless, but also life-threatening. Treatment of the disease takes place only in the condition of the clinic. Before treating a fistula, the doctor conducts a detailed diagnostic examination. It helps to establish the extent of the fistulous lesion and its causes. The main principles of therapy are the removal of a festering ligature. It is necessary to take a course of anti-inflammatory drugs and antibiotics.

It is necessary to strengthen the immune system. A strong immune system is the key to a cure for many pathologies. Elimination of formation is impossible without regular sanitation of the cavity. A solution of furacillin or hydrogen peroxide is used as a washing liquid, they remove pus and disinfect the edges of the wound. Antibacterial agent should be administered only on the advice of a physician.

When ineffective treatment fistula operation is shown. It consists in removing ligatures, scraping, cauterization. The most gentle way to remove festering ligatures is under the influence of ultrasound. With timely and quality treatment the likelihood of fistula complications is minimal. Emergence inflammatory reactions in other tissues human body minimum.

Postoperative fistula in some cases can be created artificially. So, for example, it can be created for artificial feeding or withdrawal stool.

How to get rid of a fistula?

You don't have to wait for healing to happen. Lack of treatment can provoke an increase in suppuration and its spread throughout the body. The doctor can use the following techniques and steps to remove the fistula:

• dissection of tissue in the affected area to remove pus;
• excision of the fistula, cleaning the wound of pus and its subsequent washing;
• removal of suture material blindly (if possible);
• if it is impossible to remove the suture material blindly, the doctor makes a second attempt (further dissection of the zone is carried out in last turn, as this measure may provoke further infection);
• the ligature can be removed using special tools (this is done through the fistula canal without additional dissection, which reduces the risk of further secondary infection);
• held debridement wounds (in case of unsuccessful removal of the fistulous canal, the wound is treated with an antiseptic).

If the patient has strong immunity, then the fistula can heal quickly, and inflammatory complications are not observed. It can self-destruct in very rare cases. Only with an inflammatory process of a slight degree of intensity, the patient is prescribed conservative treatment. Surgical removal a fistula is indicated when a large number of fistulas appear, and also if the outflow of pus is very intense.

Remember that a healing antiseptic only temporarily stops inflammation. To permanently cure the fistula, you need to remove the ligature. If the fistula is not removed in time, this leads to chronic course pathological process.

Why are bronchial fistulas dangerous?

Bronchial fistula is pathological condition bronchial tree, in which it communicates with the external environment, the pleura or internal organs. Meet in postoperative period as a consequence of the insolvency of the bronchus stump, necrosis. This type of bronchial fistula is a frequent consequence of pneumoectomy due to lung cancer and other resections.

Common symptoms of bronchial fistula are:

If water enters such a hole, then a person has a sharp paroxysmal cough and suffocation. Withdrawal pressure bandage provokes the appearance of the above symptoms, including loss of voice. Dry barking cough - sometimes a small amount of viscous sputum can be coughed up.

If the fistula develops against the background purulent inflammation pleura, then other symptoms come first: secretion of mucus with pus, with an unpleasant fetid odor, pronounced suffocation. Air is released from the drain. Possible development of subcutaneous emphysema. As complications, the patient may have hemoptysis, bleeding from the lung, aspiration pneumonia.

The connection of the bronchus with other organs causes the following symptoms:

• coughing up food or stomach contents;
• cough;
• asphyxia.

The danger of bronchial fistulas refers to high risk complications, including pneumonia, blood poisoning, internal bleeding, amyloidosis.

Urogenital and intestinal fistulas

Genitourinary fistula appears as a complication of operations on the genitals. Most often, messages are formed between the urethra and the vagina, the vagina and the bladder.

Symptoms of urogenital fistulas are very bright, and it is unlikely that a woman will be able not to detect them. With the development of the disease, urine is excreted from the genital tract. Moreover, urine can be excreted both immediately after urination, and all the time through the vagina. In the latter case voluntary urination a person does not have. If a unilateral fistula is formed, then women most often have urinary incontinence, while arbitrary urination persists.

Patients feel severe discomfort in the genital area. During active movements, such discomfort increases even more. Sexual intercourse becomes almost completely impossible. Due to the fact that urine is constantly and uncontrollably excreted from the vagina, a persistent and unpleasant odor comes from patients.

Postoperative fistulas of the rectum are also possible. The patient is concerned about the presence of a wound in the area anus and the discharge of pus, sanious fluid from it. When the outlet is blocked with pus, a significant increase in the inflammatory process occurs. During increased inflammation, patients complain of severe pain sometimes hindering movement.

The fistula seriously worsens general state sick. Prolonged inflammation disrupts sleep, appetite, a person's performance decreases, and weight decreases. Because of inflammatory phenomena anal deformity may occur. The long course of the pathological process can contribute to the transition of the fistula into malignant tumor- cancer.

Disease prevention

Preventing the development of a fistula does not depend on the patient, but on the doctor who performed the operation. The most important preventive measure is the strict observance of the rules of disinfection during the operation. The material must be sterile. Before suturing, the wound is always washed with an aseptic solution.

What is a fistula (fistula)? This is a pathologically formed channel (tube) connecting hollow organ or a tumor with the environment or two organs (or cavities) between them. In the cavity of such a fistula, there is always a secret or exudate, which maintains a constant inflammation of the fistula. Spontaneous cure of this pathology is impossible, favorable outcome (full recovery) is possible only with surgical intervention.

anal fistula

The term "anal fistula" is used to denote a pathologically formed passage connecting the rectum and the hole formed on the skin in the anal region. Such a fistula passes through the pararectal tissue and opens with one or more holes. The disease is complicated by the fact that the process is spontaneously inflamed by fecal masses protruding into the cavity of the fistula and is located inside the pararectal tissue, which is easily susceptible to infection. Methods of conservative elimination of pathology rarely bring results, in the event of paraproctitis, and even more so, the formation of a fistula requires an appeal to a surgeon - a proctologist.

Causes of the disease

To understand the pathophysiology of the process, it is necessary to determine from what the fistula appears. The reasons for the formation of a pathological message can be specific - as a result of certain diseases:

• tuberculosis infection;
• actinomycosis;
• malignant and benign formations rectum;
• tissue injury;
• unsuccessful surgical interventions for various diseases.

The most common cause of fistula formation non-specific factors, namely (inflammation in one of the crypts of the anal canal).

Important! With self-treatment of acute paraproctitis, there is a high probability of fistula formation after spontaneous opening of the abscess.

Are rectal fistulas dangerous?

In addition to unpleasant symptoms, a fistula of the rectum creates a risk of developing the following complications that pose a threat to the health and life of the patient:

1. blood poisoning (sepsis);
2. the formation of scars in the fiber along the pathological canal, which leads to spontaneous release of feces and intestinal gases;
3. the formation of scars along the walls of the anus, which is expressed in the soreness of the act of defecation and minor bleeding with each stool;
4. fistulas of the rectum are able to degenerate into oncological disease(rectal cancer).

Even without development serious complications rectal fistulas impair the quality of life of the patient, making normal social life impossible due to the constant leakage of feces, accompanied by a characteristic odor.

Classification

The fistula of the anus has its own characteristics during the course of the disease, depending on the location, the number of holes and branches, the presence of pathological processes along the canal and the stage of inflammation.

Types of fistulas depending on localization

The modern classification describes fistulas taking into account the factors listed above.

According to the location of the fistula openings:

• a complete fistula originates in the rectum and ends with a skin outlet in the anus. The fistula can be simple (1 inlet and 1 outlet connected by a straight tube) and complex (has 2 or more inlets, forms an extensive network of tubes in the intestinal tissue and ends with one or more "holes" in the anus);
• incomplete is characterized by an incomplete breakthrough of the abscess, a hole from the rectum with the formation of a blind canal in the adrectal tissue. This condition is transient and, with further inflammation, it will break either outward or into the intestinal cavity;
• internal fistula is characterized by the presence of an inlet and outlet in the cavity of the rectum, the channel between the holes is located in the intestinal tissue.

By localization relative to the sphincter:

1. Intrasphincteric move. Such a fistula of the rectum is treated conservative methods not fed, located on the edge of the anus and has a direct course;
2. transsphincteric fistula has many passages, pockets and a tortuous course. Leads to the formation of scars along the "tube" near the intestinal space, passes through the muscles of the sphincter, deforming it, which is accompanied by the formation of incontinence;
3. extrasphincteric. It originates above the sphincter, without affecting its muscles, and exits with one or more openings at the anus.

Advice. If acute paraproctitis occurs, you should immediately contact a proctologist surgeon for the purpose of excision and full treatment. With absence timely assistance during paraproctitis, a fistula is formed, which significantly worsens the prognosis.

The tactics of managing the patient will depend on the type of fistula, the degree of its development and localization.

Symptoms

The fistula of the rectum is manifested by the following symptoms:

• a feeling of itching and discomfort in the anal area persist for a long time;
• the patient is disturbed by the discharge of pus or ichor, accompanied by a fetid odor. Discharges are found on underwear and skin. Constant washing and anti-inflammatory sitz baths, together with the wearing of protective pads, only slightly reduce unpleasant manifestations. A person cannot lead a normal life and work under normal conditions;
• there is pain in the anus when exerting, during a chair, coughing or sitting;
• sometimes there is an increase in body temperature.

Important. The course of the disease is undulating and has periods of remission and exacerbation, the longer the process remains unresolved, there big square near the intestinal tissue is involved in the pathological process.

Exacerbation of the disease and the formation of fresh foci of infection is accompanied by common signs of intoxication: decreased performance, weakness, drowsiness against the background of insomnia, fever.

When forming a fistula of the rectum, the symptoms in men do not differ from those in women, however, in most cases, there is a decrease in potency followed by the formation of erectile dysfunction.

Treatment

After making a diagnosis, the doctor chooses the tactics of managing the patient. The treatment of a fistula will depend on the form of the disease and the degree of its development, the presence of complications and concomitant diseases organism. Considering the need for surgical intervention in serious condition patient or serious inflammatory processes of the body is prescribed drug therapy aimed at eliminating these factors. After elimination life threatening situation, surgery is scheduled.

How to treat a fistula of the rectum is decided by the doctor individually with each patient, not only the condition and shape of the fistula, but also the surgeon's capabilities affect the adoption of a particular decision. During an exacerbation it is possible local treatment(baths, ointments, powders), which consists in protecting the skin from the negative effects of secretions and the use of antibiotics to relieve the inflammatory process. After cupping acute course surgical treatment is carried out in order to heal the resulting fistula.

Fistulectomy

This technique is used for primary fistulas, mainly subcutaneous and intersphincteric.

The fistulectomy technique is as follows: a surgical probe is inserted into the fistula channel through an internal or external hole, after which the specialist dissects the tissues throughout the channel in order to heal the tissues. This method usually does not violate the function of the sphincter, except for severe and neglected cases.

The granulation tissue lining the canal is removed with a surgical curette. Complete excision of the edges of the canal allows you to prevent recurrence of the pathology.

Ligature method

Complicated rectal fistula involves a more complex operation, used independently or in conjunction with fistulectomy.

A ligature (draining material, it can be a thin tube or a silk thread) is inserted into the lumen of the canal and carried out throughout the fistula. The ligature allows you to navigate with the volume of the affected tissue. The introduction of drainage allows you to speed up the regeneration process due to the outflow of exudate and control over the closure of the inlet and outlet.

Indication for choosing a ligature method:

• complex and branched fistulas;
• multiple formation of fistulas (2 or more);
• relapse after fistulectomy;
• decrease in sphincter tone, determined before surgery;
• impaired immunity.

Movement of the skin flap

The method is chosen for high fistulas and frequent recurrences after excision. With this type of operation, the entire affected surface is excised with further mixing of the flap onto the affected surface. The method is not allowed acute inflammation and some diseases internal organs.

Treatment with fibrin glue

The technique is acceptable for a simple fistula at an early stage of development. Fibrin glue is introduced into the fistula cavity, which promotes rapid regeneration. In the absence of the effect of this type of treatment, excision of the edges of the fistula is prescribed with or without a ligature, at the discretion of the surgeon.

Laser processing

The fistula of the anus is exposed laser processing treatment is possible with simple uncomplicated processes. The effectiveness of this procedure exceeds 80% of the manipulations performed, complete cure without relapses and all kinds of complications.

Important. Treatment of fistula at home using traditional medicine methods is not acceptable. The longer the process is left without the attention of a specialist, the more difficult it will be to get rid of the pathological process.

Postoperative period

After excision of the fistula of the rectum, the patient requires medical supervision and additional treatment throughout the postoperative period.

In the early postoperative period (2-4 days), analgesics are prescribed to reduce pain syndrome.

About a week after the operation, it is necessary to adhere to special diet(the first days are liquid food, followed by the introduction of more serious dishes).

Until the wound heals, sitz anti-inflammatory baths should be taken at least 3 times a day, additionally after each act of defecation.

If you experience signs of inflammation, you should contact your doctor, namely:

• hyperthermia (an increase in body temperature indicates the onset of inflammation);
• difficulty emptying the bowels or bladder;
• the appearance of incontinence of gases or feces;
• the appearance and intensification of pain in the perineum 3-4 days after surgery;
• the occurrence of pain in the abdomen;
• the appearance of purulent discharge.

Possible complications in the early and late postoperative period.

Fistulas or fistulas of the rectum (fistulae ani et recti) is a serious pathology associated with the formation of purulent passages through the connective tissue of the rectum. The exit of the fistulous tunnels may end in the perirectal tissue. These are incomplete internal fistulas. More often, the passages are completely open and open through the skin in the anus area, the so-called complete external fistulas.

What is a rectal fistula?

Fistula of the rectum is a chronic inflammatory process anal gland, usually located in the region of the morganian crypts (anal sinuses), as a result of which a passage is formed in the wall of the rectum, through which inflammation products (pus, mucus and ichorus) are periodically released.

Fistula is a chronic paraproctitis, in which constant allocation pus from the fistula. From the inside, the passage is covered with epithelium, which prevents it from closing and self-healing.

ICD-10 disease code:

• K60.4 - Rectal fistula. Skin (full).
• K60.5 - Anorectal fistula (between anus and rectum).

The mere presence of a hearth chronic infection adversely affects the body as a whole, weakening the immune system. Against the background of fistulas, proctosigmoiditis can develop. In women, infection of the genital organs with the development of colpitis is possible.

Causes

The occurrence of fistulas is associated with an infection penetrating the intestinal lining and surrounding tissues. Inflamed first adipose tissue around the gut (). At the same time, pus begins to accumulate.

Ulcers break out over time leaving tubules called fistulas. They may scar or continue to become inflamed and fester.

In proctology, about 95% of rectal fistulas are the outcome of acute paraproctitis. The infection, penetrating deep into the wall of the rectum and the surrounding tissue, causes the formation of a perirectal abscess, which opens, forming a fistula. The formation may be associated with the untimely appeal of the patient to the proctologist, the non-radical surgical intervention for paraproctitis.

The nature of the disease, in addition to the considered connection with acute paraproctitis, may also be postoperative or post-traumatic. For example, in women, fistulas at the connection of the vagina and rectum are mainly formed as a result of birth injuries, which can occur, in particular, due to ruptures of the birth canal, with prolonged labor or breech presentation of the fetus.

Rough forms of gynecological manipulations can also provoke the formation of fistulas.

The reasons for the formation of a fistula are as follows:

• untimely visit to the doctor with the development of paraproctitis;
• incorrectly prescribed treatment;
• improper operation to remove an abscess, accompanied only by opening and draining the abscess without prescribing a properly selected antibiotic therapy.

The appearance of fistulous openings in the anus can also be associated with such diseases:

• diverticulitis (inflammation of the lining of the large intestine)
• rectal tuberculosis

Kinds

All types of fistulas have the same structure - inlet, channel and outlet. The inlet can be formed in different places, For example:

• near the anus;
• on the buttock;
• in the perineum;
• in the vagina or close to it (rectovestibular fistula);
• in the layers of subcutaneous tissue.

Depending on how the fistulous passage is located in relation to the anal sphincter, intrasphincteric, extrasphincteric and transsphincteric fistulas of the rectum are determined.

1. Intrasphincteric fistulas are the simplest, they are diagnosed in the range of 25-30% of cases of the formation of such formations. Their other designations are also used in this variant, namely, marginal or subcutaneous-submucosal fistulas. They are characterized by the directness of the fistulous course, the unexpressed manifestation of the cicatricial process and the insignificant duration of the course of the disease.
2. Transsphincteral. The fistulous passages of such formations contain purulent pockets, branching in the pararectal tissue and cicatricial changes caused by purulent fusion of tissues. The channels of such fistulas pass through the superficial, subcutaneous or deep portion of the sphincter.
3. Extrasphincteric rectal fistula is the most complex view, affecting most of the sphincter, and at the same time having streaks of various forms. The treatment is quite complex with various plastic forms, and is even carried out in several stages.

Symptoms of a rectal fistula in adults

Manifestations of a fistula of the rectum depend on the location of the fistula with purulent contents and the state of the immune system, which will determine the severity of the manifestations of such a pathological formation.

After suffering paraproctitis in a patient:

• there is pain in the anus;
• a hole appears from which pus is released (its traces will be visible on linen and / or clothing).

Sometimes, along with the purulent discharge, an ichor remains on the tissue, which appears due to damage to the blood vessels. If the fistula does not have an external outlet, then the patient has only pain and / or discharge from the lumen of the rectum or vagina.

The presence of incomplete internal fistulas causes patients to feel the presence of a foreign body in the anus. With insufficient exit of the infiltrate from the fistula cavity, patients feel:

• pain and discomfort in the anus
• retention of stool and urination
• discharge from the rectum (pus, infiltrate, mucus)
• irritation and redness of the skin around the anus and part of the buttocks
• fever, chills.

At chronic form diseases, especially during the period of exacerbation, the following set of symptoms is noted:

• fast fatiguability;
• nervous exhaustion;
• bad sleep;
• headache;
• body temperature rises regularly;
• intestinal gas incontinence;
• disorders in the sexual sphere.

There may also be pathological changes in physical terms:

• the rear opening is deformed;
• scarring of the muscle tissue of the sphincter appears;
• dysfunction of the sphincter.

During the period of remission, the general condition of the patient is not changed, and with careful hygiene, the quality of life does not suffer much. However long course fistula of the rectum and constant exacerbations of the disease can lead to:

• asthenia,
• sleep deterioration,
• headache,
• occasional rise in temperature
• decrease in work capacity
• nervousness
• decrease in potency.

Depending on the stage and form of the disease, the signs alternate.

Diagnostics

At the initial stage, a patient is interviewed, during which complaints characteristic of this pathology are identified. Diagnosis of a fistula usually does not cause difficulties, since already during the examination, the doctor discovers one or more openings in the anal area, when pressed on which the purulent contents are separated. At digital examination specialist can find inner hole fistula.

In addition to examination and history taking, the patient is prescribed tests:

• blood chemistry,
• general analysis of blood and urine,
• stool test for occult blood.

Instrumental methods for diagnosing fistulas of the rectum:

1. Sigmoidoscopy is an endoscopic examination of the rectum using a tube inserted into the anus. This method allows visualization of the rectal mucosa, as well as a biopsy, in order to differentiate a rectal fistula from a tumor, in case of suspicion.
2. In order to clarify the position of the fistula of the rectum and the presence of additional branches, ultrasonography is performed - ultrasonography pararectal tissue.
3. Fistulography is an x-ray contrast study, when a special contrast agent is injected into the hole, then pictures are taken. They can be used to judge the direction of the fistula and the location of the purulent cavity. This study must be carried out before the operation.

Treatment

It is important to understand that fistulas are not treated with medications and traditional medicine. The only cure, which allows you to achieve a complete cure for the disease - surgical.

Medical therapy is used solely to relieve symptoms and as aid accelerating recovery.

• fourth-generation systemic antibiotics for oral administration: Metronidazole, Amoxicillin;
• painkillers: Detralex, Hemoroidin, Phlebodia;
• healing drugs with anti-inflammatory properties (externally): Levosin, Levomekol, Fusimet.
• physiotherapeutic procedures in a full course: electrophoresis, UVI.

Operation

Fistula treatment is surgical. The main goal is to block the entry of bacteria into the cavity, its cleansing and excision (removal) of the fistulous passage.

The operation to remove the fistula of the rectum is usually prescribed in a planned manner. With an exacerbation of chronic paraproctitis, an abscess is usually urgently opened, and the fistula is removed after 1-2 weeks.

Contraindications for surgery:

• Severe general condition.
• Infectious diseases in the acute period.
• Decompensation of chronic diseases.
• Violation of blood clotting.
• Renal and liver failure.

Depending on the complexity of the fistula, following methods surgical intervention:

• excision throughout the fistula with or without wound closure;
• excision with plasty of the internal fistulous opening;
• ligature method;
• laser cauterization of the fistula;
• sealing with biomaterials of the fistulous tract.

A competently performed operation in a specialized hospital in 90% guarantees a complete cure. But, as with any operation, there may be undesirable consequences:

• Bleeding both during and after surgery.
• Damage to the urethra.
• Suppuration of the postoperative wound.
• Insolvency of the anal sphincter (incontinence of feces and gases).
• Fistula recurrence (in 10-15% of cases).

Hospital stay after surgery:

1. The first days, when the patient is in the hospital, a gas outlet tube is placed for him, analgesics, antibiotics are prescribed, dressings are performed.
2. From the 2nd day, food is allowed - sparing and easily digestible food in shabby form, plentiful drink. Sedentary baths with a warm solution of antiseptics, anesthetic ointments, laxatives, antibiotics if necessary are prescribed.
3. The length of stay in the hospital after the intervention may be different - from 3 to 10 days, depending on the extent of the operation

After discharge from the hospital, the patient should be especially attentive to his own well-being and immediately consult a doctor if the following symptoms occur:

• Rapid rise in temperature
• Constant pain in the abdomen
• Fecal incontinence, excessive gas
• Painful bowel movements or urination
• The appearance of purulent or bloody discharge from the anus.

It is very important that the first 2-3 days after the operation the patient did not have a stool. This will provide the wound with sterile conditions for healing. In the subsequent time, the diet expands, however, constipation, which can provoke a divergence of the seams, must be avoided. Additional recommendations:

• Meals should be fractional, 6 times a day in small portions.
• It is important to drink enough fluids, at least 2 liters of water per day, so that the body recovers faster, and also to prevent constipation.
• Foods should not be consumed irritating intestines. These include carbonated and alcoholic drinks, chocolate in large quantities, hot spices and flavor additives, chips, fatty meats, etc.

Forecast:

1. Intrasphincteric and low transsphincteric fistulas of the rectum are usually amenable to permanent cure and do not entail serious complications.
2. Deep transsphincteric and extrasphincteric fistulas often recur.
3. Long-term fistulas, complicated by scarring of the rectal wall and purulent streaks, may be accompanied by secondary functional changes.

Prevention

Effective prevention of the inflammatory process of the rectum are the following recommendations specialist:

• balanced and fortified diet;
• the final rejection of all bad habits;
• timely treatment of chronic diseases of the digestive tract;
• rejection of emotional shocks and stress.

Fistula of the rectum is dangerous disease, which can cause discomfort with its unpleasant symptoms and cause complications. When the first signs appear, be sure to seek help from a proctologist.

The treatment of fistulas is to take measures that contribute to the spontaneous closure of the fistula. During the formation of the fistula, measures are taken to eliminate the inflammatory process in the pathological focus, normalize the metabolic functions of the body, antibiotic therapy. With, urinary and biliary fistula in the presence of purulent and abundant discharge from these organs, it is recommended to drain the fistula with diversion, urine and bile into a separate bowl. It is advisable to use delimiting tampons with hypertonic saline, etc. These measures allow you to quickly eliminate the inflammatory process in the wound and create favorable conditions for self-closure of the fistula. In patients with external fistulas, maximum protection skin around the fistula, as in the absence proper care skin complications can occur - dermatitis, etc.

The care of patients with fistulas created to provide nutrition to the patient (gastrostomy, jejunostomy) has its own characteristics (see Gastrostomy,).

The rules for caring for patients with purulent fistulas are careful hygiene of the skin around the fistula. The fistula area should be washed daily with warm boiled water, and if the general condition of the patient allows, daily hygienic baths are recommended. If there are excessive granulations around the fistulous opening, it is possible to produce fistula edges with iodine, 3% nitric acid solution, followed by application sterile dressing. Strive for bone removal, foreign bodies, it is impossible to make curettage of the fistulous tract without consulting a surgeon. In order to eliminate inflammation in the depth of the tissue, it is possible to recommend washing the fistula with antibiotic solutions; physiotherapy treatment - quartz, .

Patients with bronchial fistula are forced to constantly wear bandages and change them frequently. With a fistula of a significant diameter, patients should constantly wear an obstructive bandage, since when the bandage is removed, the patient experiences difficulty breathing, shortness of breath, etc. It is impossible to take general baths, since water can penetrate the bronchial tree through the fistula and cause respiratory distress. You can only wash in the shower. If there is skin and pustules around the fistula, you can lubricate the skin for healing with a strong solution, brilliant green, or apply bandages with 5% synthomycin, streptocidal, and prednisolone ointment, etc.

As a result of an inflammatory process or surgical intervention, a so-called fistula can form - a channel connecting two cavities to each other or an organ to the surface of the body. Inside the fistula is filled with exudate, so over time the inflammation progresses. Such a pathology cannot heal on its own, a mandatory drug treatment or surgical intervention.

What is a fistula

As a result of various pathological processes, purulent fluid accumulates in the focus of inflammation - it consists of bacterial cells along with their metabolic products and dead leukocytes. During the development of pathology, the amount of exudate gradually increases, it does not fit in the cavity, so the body tries to give it an outlet. This is how a fistula is formed - a fistula (tube, channel), which connects the affected cavity or organ to the exit site of the exudate (the surface of the skin or another cavity).

Through the fistula, the surface of which is covered by an epithelial layer or granulation tissue, a purulent secret constantly passes, increasing inflammation, therefore, spontaneous healing of such a pathology is problematic, but in some cases it is possible. In addition, fistulas often have multiple branches, making it difficult to prompt removal pathology.

Under certain conditions, microorganisms purulent fluid can “migrate” to surrounding organs and tissues, provoking the appearance of new foci of inflammation. The composition of the separated substance directly depends on the organ with which the channel is connected; the more aggressive the secret, the more it damages the skin or nearby tissues. When fistulas occur, there is a loss of fluid, intoxication of the body, which leads to metabolic disorders and water-salt balance.

Fistulas can exist in the body for a long time and, if not properly treated, affect several organs. If the inflammation of the original organ is stopped, the canal ceases to receive purulent discharge, it closes and heals. When the pathological process resumes, the fistula begins to function again, accumulate and secrete exudate - a relapse occurs.

What does a fistula look like

There are internal fistulas, which connect the cavities inside the body, and external ones. A fistula on the skin looks like an inflamed wound, from which pus oozes, the edges may resemble lips. An external fistula occurs on skin near cavities, such as in the throat and nose. In some cases, a person may not be aware of the presence of an inflammatory process in the body until a fistulous opening appears on the surface of the skin. In case of severe damage to the internal organs, not only purulent exudate, but also fecal, urinary, bile.

What does it come from

As etiological factor gram-negative, anaerobic bacteria, streptococcus aureus, staphylococci, some types of fungi, etc. can act. Fistulas are formed by the following reasons:

• tuberculosis infection;
• Crohn's disease (severe chronic disease gastrointestinal tract);
• actinomycosis − chronic diseases arising from infection with a fungus;
• complications after surgery (for example, a ligature fistula is formed due to suppuration around the sutures on blood vessels);
• chronic ENT diseases;
• the presence of sequesters - dead areas of the bone;
• injuries of the intestinal tissue;
• dental pathologies (periodontitis, caries);
• paraproctitis - inflammation in the crypts of the anal canal of the intestine;
• neoplasms (benign and malignant) on the rectum;
• suppuration around foreign bodies inside the body (for example, a bullet or its fragments).

Symptoms

The signs of a fistula in most cases are similar, depending on the location of the focus of inflammation and the affected organ. With pathology, the patient observes the following symptoms:

• subfebrile temperature body due to the presence of an inflammatory process in the body;
• signs of intoxication - weakness, headaches and muscle pain, sleep disturbance, decreased performance;
• the presence of a characteristic pain syndrome, if the fistulous course affects nerve endings(for example, a fistula of the rectum is accompanied by painful sensations in the anus, which are aggravated during bowel movements);
• the pain subsides after the bubble breaks through at the end of the canal and the secretion is released onto the skin or into the cavity.

Kinds

There are several classifications of fistulas. Distinguished by origin the following types:

1. Congenital fistulas are formed due to malformations of the embryo; some of them (for example, umbilical fistula) are detected by doctors before or during childbirth.
2. Acquired pathological channels arise due to inflammatory processes, injuries or operations (for example, a fistula on a leg or arm may occur due to a fracture or bruise).
3. Artificially created fistulas are designed to remove fluids from the body (purulent, urinary, fecal, bile).

By location, fistulas are divided into the following types:

1. Urinary - installed on the ureters, bladder or urethra possibly formed as a result of trauma.
2. Biliary fistulas occur due to operations performed on gallbladder. The secret secreted by such a fistula leaves burns on nearby tissues, so treatment should be started immediately.
3. Purulent canals can occur anywhere on the body, often they appear on the gums due to a poorly healed tooth. In rare cases, a purulent fistula can heal on its own, but more often a relapse occurs and purulent exudate begins to flow through the canal again.
4. Salivary fistulas are formed due to inflammatory processes in the cheek, neck or ear, saliva is secreted through them.
5. Bronchial - connects bronchi to pleural cavity.
6. Gastric fistulas are artificially established for enteral feeding of the patient after gastric resection with deviations of the digestive system and gastrointestinal tract.
7. There are fistulas of the upper and lower divisions small intestine. The former arise due to injuries or operations, often heal on their own with proper care, the latter are created by surgeons to remove feces in case of intestinal obstruction or peritonitis (fecal fistula).
8. Canals in the large intestine are caused by injuries, operations, or are artificially installed. Often heal on their own, but require special care - use protective ointments to avoid injury.

Diagnostic methods

For staging accurate diagnosis the doctor gets acquainted with the patient's history, palpates the inflammatory focus, evaluates the number and appearance secreted fluid, asks the patient about complaints about violations of the functioning of internal organs. After that, the doctor directs the patient to further diagnostic measures:

• A blood and urine test, blood culture for the presence of pathogenic bacteria can indicate the presence of inflammation and its nature.
• CT ( CT scan), MRI (magnetic resonance imaging) are often used as a means of diagnosing fistulas.
• One of the most effective methods is radiography with the introduction contrast agent into the fistula cavity to determine the size, length, branching of the fistula.
• The probing method is considered no less effective; it is used only in cases of external fistulas, in which the outer edge comes to the surface of the skin.
• Studies of purulent fluid are used to determine the primary organ that gave rise to the pathological canal.
• During the operation to remove the fistula, specialists inject staining substances (for example, methyl blue) to assess the entire structure of the canal and accurately identify the original organ.
• Ultrasound is rarely used to diagnose fistulas, because this method is less informative.

Fistula treatment

In fact, a fistula is a tube with dead bacterial remnants, often its treatment consists in excising the canal, cleaning it with chemical or mechanically and removing the inflammation of the organ from which the fistula began. For example, when getting rid of the fistula of the rectum by the most effective method is surgical intervention. Full recovery of the patient occurs in 20-30 days, at which time the patient is recommended to take therapeutic baths and refrain from physical exertion to avoid injury to the sphincter.

Also used to treat fistulas local funds(baths, ointments, powders, antiseptic solutions for washing, etc.). In some cases, the doctor prescribes antibiotics to eliminate bacterial infection, painkillers and antipyretics to improve the patient's condition. As drugs used for the treatment of fistulas, the following medicines are used:

Name of the drug	Active substance; dosage	Action	Indications for use	Side effects	Contraindications
Dioxysol (external use)	Lidocaine 6%, Dioxidine 1.2% in 1 ml. Solution in vials and jars of 50, 100, 500, 1000 g	Removal of pain syndrome; antibacterial effect on a wide range of microorganisms	festering wounds and fistulas, burns, abscesses	Bradycardia, nervousness, depression, arterial hypotension	Pathologies of the cardiovascular system; pregnancy, lactation, childhood
Chlorhexidine bigluconate (external use)	Chlorhexidine bigluconate 0.05% in 1 ml. Solution in vials of 40, 80, 100, 200 ml	Bactericidal action	Prevention sexually transmitted diseases, burns, abscesses, fistulas, wounds	Dermatitis, allergies, itching and burning of the skin	Viral diseases skin, dermatitis, hypersensitivity to the components of the drug
Miramistin ointment (external use)	Miramistin 5 mg per 1 g of ointment. Banks of 1000 g, tubes of 15, 30 g	antiseptic, antimicrobial action. Therapeutic effect enhanced by deep penetration into the lower layers of the skin Ointment Used as home ointments the following means: In a 1:1 ratio, mix vodka and olive oil, treat the affected area with the mixture several times a day, then apply cabbage leaf to remove pus. For achievement maximum effect the product is used for several weeks. Fresh calendula flowers are tightly folded into a glass container, poured with melted butter, insist 12 hours. After that, place in the oven for 48 hours (at a temperature of 70 degrees). The medicine is stored in a container with a sealed lid in a dark place. The resulting agent lubricates the inlet of the fistula. 200 g finely chopped onion, pour hot pork fat, heat in a pan until the onion darkens. The resulting mixture is infused for 6 hours, shaking occasionally. A fistula is treated with such an ointment, alternating with other means. Decoctions A few examples of tinctures and decoctions for the treatment of fistulas: Equal amounts of aloe juice and mummy juice are mixed (after soaking it in water), a bandage soaked in the solution is applied to the sore spot for a long time. 2 tablespoons of St. John's wort pour 2 cups of water, boil the mixture for 10 minutes, filter the resulting solution. The mixture is spread on a film and the sore spot is wrapped with such a compress, then the focus of inflammation is washed with the remaining solution. The agent is used until the channel begins to release exudate. For the treatment of external fistulas, a tincture of dandelion flowers is prepared on a triple cologne. The resulting liquid is instilled with a pipette directly into the fistula channel to achieve the maximum therapeutic effect. Video