Intestinal fistula is a complex, dangerous, troublesome and torturous condition that is often related to surgery, but not necessarily the fault of the doctor. It is common to hear doctors whine, “The surgery went pretty well, how could it leak?” There are also family members of patients who complain: “Others were discharged in 2 weeks after the same surgery, but we are still not well after 2 months, and the drainage tube just won’t come out” This is usually the result of an intestinal fistula, which is a disaster for the patient and a nuisance and torture for the doctor.
So what exactly is an intestinal fistula?
We know that the intestine is normally an elastic, contracting system of tubes, where the food we eat first enters the stomach, is stirred and digested by the stomach, and then discharged into the intestine, where it is absorbed by the small intestine and turned into feces. If there is a leak in one part of the intestine, like a burst pipe, the contents of the intestinal cavity (food, intestinal fluid, residue) will overflow from the breach, and because intestinal fluid is alkaline, it will burn the surrounding area, and there are many bacteria in the intestine, which will lead to abdominal infection. If the intestine is leaking, the patient cannot eat and becomes malnourished.
What causes intestinal fistulas?
We have counted a large number of patients with intestinal fistulas that we have treated and found that three types of patients are the most frequent: trauma, tumors, and Crohn’s disease. The majority of patients have fistulas after surgery.
How do you get a fistula after surgery?
First of all, it has to do with disease, and some diseases are prone to enterocutaneous fistulas. For example, the intestinal wall is contused and edematous after trauma; the surgical anastomosis of patients with gastrointestinal tumors does not heal easily; the inflammation of the intestinal wall in Crohn’s disease is not conducive to healing and is prone to inflammation and breakdown after surgical stress.
Secondly, it is related to the systemic condition of the patient. For example, patients with shock, anemia, jaundice, malnutrition, diabetes mellitus, etc. have poor tissue healing ability, so the anastomosis does not heal easily after gastrointestinal surgery.
Again, it is important to mention the surgeon’s surgical technique, the preservation of blood vessels, the level of anastomosis, and the anastomotic materials and tools used are all closely related to the occurrence of intestinal fistulas.
Finally, some foreign bodies, certain medical procedures (especially new ones), and accidental injuries are possible causes of intestinal fistulas.
So, how do we know if it is an intestinal fistula?
First of all, we can basically identify an intestinal fistula if we find yellow fluid, food residue, or fecal-like fluid in the trauma, incision, or abdominal drainage tube.
Secondly, if there is a leak after trauma, after gastrointestinal surgery or if a Crohn’s patient has persistent fever, abdominal pain or even sudden respiratory distress, it is important to think about it.
In addition, persistent leakage after removal of the drainage tube after surgery, or a delayed incision, especially an inexplicable abscess, may be a sign of an intestinal fistula.
Of course, the doctor’s judgment and further tests are needed, and CT and transdrainage or sinus imaging are the gold standard for diagnosing intestinal fistulas.
What do we do once an intestinal fistula occurs?
The first thing to do is not to rush to tangle with the doctor and file a lawsuit, because there are more important things to do, which is to find the right hospital and the right doctor to treat it. As for whether the doctor is responsible for the cure and then to think about it is too late.
The second thing is to be prepared for a long battle, because once the intestinal fistula occurs, the treatment period is very long, counted in months and even years.
It is recommended to seek treatment from a professional doctor. The average surgeon does not treat many patients with intestinal fistulas in their lifetime and can be overwhelmed by the complexity of the situation, especially when faced with a fistula that occurred after their own surgery. Therefore, finding a doctor who is experienced in this field and quickly starting a regular and systematic treatment will have a miraculous effect with half the effort.