Enterocutaneous Fistula
An abnormal channel between the intestine and the skin
Quick Facts
- Type: Digestive (gastrointestinal) complication
- What it is: A tunnel between bowel and skin
- Common causes: Surgery, Crohn's disease, infection
- Key effects: Leakage, infection, fluid and nutrition loss
Overview
A fistula is an abnormal tunnel that connects two surfaces that should not be joined. An enterocutaneous fistula is a channel that forms between the intestine ("entero") and the skin ("cutaneous"), so that intestinal contents leak out through an opening on the surface of the abdomen.
These fistulas most often develop after abdominal surgery, but they can also arise from Crohn's disease, infection, injury, or cancer. They range from a minor nuisance to a serious problem, because leaking digestive fluid can damage the surrounding skin, cause infection, and lead to loss of fluids and nutrients. Many require a combination of skilled wound care, nutritional support, and sometimes surgery to close them.
Symptoms
The most obvious sign is leakage of intestinal contents through an opening in the skin of the abdomen. Other features depend on how much fluid leaks and what else is going on.
- Drainage of fluid, digestive juice, or stool from a skin opening, often near a surgical wound
- Red, raw, or broken-down skin around the opening from irritating fluid
- Abdominal pain or tenderness
- Signs of infection such as fever and increasing redness
- Dehydration, weakness, and weight loss when output is high
- Malnutrition over time if large amounts of fluid and nutrients are lost
High-output fistulas, which leak large volumes, can quickly cause dangerous fluid and salt imbalances and need close medical management.
Causes
Enterocutaneous fistulas usually form when the bowel wall is damaged or fails to heal and an abnormal path develops to the skin. Common causes include:
- After surgery: The majority follow abdominal operations, often related to an anastomotic leak or wound complication.
- Crohn's disease: This inflammatory bowel disease has a strong tendency to form fistulas.
- Infection or abscess: A deep infection can erode a path to the skin.
- Injury or radiation: Trauma or previous radiation therapy can damage the bowel.
- Cancer: A tumor in or near the bowel can create a fistula.
Risk Factors
- Recent abdominal surgery, especially complicated or emergency operations
- Crohn's disease or other inflammatory bowel disease
- Previous abdominal radiation therapy
- Poor nutrition and impaired wound healing
- Abdominal infection or abscess
- Diabetes, steroid use, or a weakened immune system
Diagnosis
Doctors confirm the fistula and map its path to plan treatment:
- Examination: Observing the type and amount of fluid draining from the skin opening.
- Imaging: CT scans identify abscesses and the anatomy; a fistulogram, where contrast is injected into the opening and X-rays taken, traces the tunnel.
- Blood tests: Assess infection, nutrition, and fluid and salt balance.
Defining where the fistula starts in the bowel, how long the tract is, and whether there is a blockage or abscess beyond it helps predict whether it may close on its own.
Treatment
Treatment is often summarized by the goals of controlling the leak, protecting the skin, supporting nutrition, and giving the fistula a chance to heal.
- Fluid and nutrition support: Replacing lost fluids and salts and providing nutrition, sometimes through a vein, is a cornerstone of care.
- Skin and wound care: Specialized dressings and drainage systems protect the surrounding skin and manage output.
- Treating infection: Antibiotics and drainage of any abscess.
- Reducing output: Resting the bowel and certain medications can lower the volume of fluid.
- Surgery: If a fistula does not close on its own after time and optimization, an operation may be needed to repair it.
Many fistulas without a blockage or infection beyond them can heal with patient, supportive management.
Prevention
- Optimize nutrition before planned abdominal surgery
- Manage Crohn's disease and other bowel conditions well
- Stop smoking, which impairs healing
- Report wound problems, drainage, or fever promptly after surgery
- Control diabetes and follow post-operative care instructions
When to See a Doctor
Contact your medical team if you notice fluid, digestive juice, or stool leaking from your skin or a surgical wound, particularly after recent abdominal surgery or if you have Crohn's disease. Seek prompt care if the surrounding skin breaks down, you develop a fever, or you feel increasingly unwell. Seek emergency care if you have severe abdominal pain, signs of serious infection, or symptoms of significant dehydration such as dizziness, very little urine, and a racing heart.
Frequently Asked Questions
What is an enterocutaneous fistula?
It is an abnormal channel that connects the intestine to the skin, allowing intestinal contents to leak out through an opening on the abdomen. It most often develops after abdominal surgery or from Crohn's disease, and it can cause skin damage, infection, and loss of fluids and nutrients.
Can an enterocutaneous fistula heal on its own?
Many can, especially when there is no blockage, infection, or other problem beyond the fistula. Healing is supported by replacing lost fluids and nutrients, protecting the skin, treating infection, and resting the bowel. If a fistula does not close after time and optimization, surgery may be needed.
Why is nutrition so important with a fistula?
Because intestinal fluid carries water, salts, and nutrients, a leaking fistula can cause dehydration and malnutrition, which in turn slow healing. Careful nutritional support, sometimes given through a vein, both stabilizes the person and gives the fistula a better chance of closing.
How is the skin around a fistula protected?
Leaking digestive fluid is irritating and can quickly break down the surrounding skin. Specialized dressings, barrier products, and drainage or collection systems applied by wound care specialists protect the skin and contain the output while the fistula is treated.
References
- MedlinePlus, U.S. National Library of Medicine. Fistula.
- Crohn's & Colitis Foundation. Fistulas and abscesses.
- Mayo Clinic. Crohn's disease - Symptoms and causes.
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Crohn's Disease.