Parenteral fistula is one of the serious complications of abdominal surgery and used to have a high morbidity and mortality rate. In recent years, with the development of enteral and parenteral nutrition therapy and the application of growth inhibitors and other drugs, the cure rate of parenteral fistula has increased significantly.
1. Definition of parenteral fistula
An extra-intestinal fistula is a fistula that connects the intestine to the skin on the body surface and belongs to the category of gastrointestinal fistula. Gastrointestinal fistulas also include intestinal fistulas and fistulas of the stomach, pancreas, bile, rectum, and anal canal. It is generally referred to pathological rather than medical enterostomies.
2. Classification of extraintestinal fistulas
Tubular fistula: a fistula of different length and curvature between the fistula and the external mouth of the intestinal wall.
Lip-shaped fistula: the intestinal mucosa is ectoplasmic and forms a lip with the skin. It is mostly due to a split or defective incision in the abdominal wall.
Discontinuous fistula: also called complete fistula, in which all or nearly all of the intestinal canal is broken and almost all of the intestinal contents flow out of the body through the fistula.
Single fistula, multiple fistulas: a single fistula with one internal port and one external port; multiple fistulas with multiple internal ports and multiple external ports.
High fistula, low fistula: The fistula is called high fistula if it is proximal and low fistula if it is distal to the jejunum at 100 cm of the flexural ligament.
High-flow fistula, low-flow fistula: If the amount of intestinal fluid flow is >500ml/24h, it is called high-flow fistula. If it is <500ml/24h, it is called low-flow fistula.
3. Etiology
Traumatic: trauma, surgery, endoscopy, abortion, etc.
Non-traumatic: congenital, infectious, tumor, intestinal obstruction, etc.
4. Pathophysiological changes
Internal homeostasis imbalance: oxygen imbalance, water-electrolyte imbalance.
Malnutrition
Infection
MODS
5. Diagnosis
The presence of intestinal fluid, gas or food discharged from the wound, or the direct observation of ruptured intestinal canal from the wound surface, and the outgrown intestinal mucosa are the main clinical manifestations of intestinal fistula, and most of them are not difficult to diagnose. There are also a few fistulas with small holes, little or inconspicuous spillage, and only a small purulent sinus tract on the abdominal wall, resembling the performance of an anal fistula, which must be diagnosed by oral bone char or pigment, fistulography and barium gastrointestinal imaging.