Introduction
An intestinal fistula occurs when a part of the gastrointestinal tract forms an unusual and abnormal connection with another part of the tract or wall of other organs resulting in stomach acid leakage. Gastrointestinal fistula and enterocutaneous fistula are other names for intestinal fistula. Fistulae can be described into four types: complex fistula, intestinal fistula, extraintestinal fistula, and external fistula.
An intestinal abscess is a severe condition where a collection of infectious fluid is seen. It can get formed around any part of the intestine or any organ in the abdomen. Abscesses can be formed spontaneously anywhere in the body. Two types of abscesses are known that are skin abscess and internal abscess. Intestinal abscess comes under the internal type of abscess.
What Is Intestinal Fistula and Abscess?
Intestinal fistula and abscess are serious conditions that need treatment as soon as possible and a longer period of care. It is an unusual connection between either part of the walls of the intestine or a part of the intestine and some organs. Intestinal fluid is the collection of infectious fluid surrounding any organ or found in an enclosed shape near some organ. They can occur as some of the complications of surgery. Physicians should always discuss the risk factors of fistulae and abscesses after the surgery. In the fistula, leakage of fluid or stomach acid can be seen because of the abnormal pathway between the part of the intestines or organs. In the case of an abscess, infected fluid gets collected either in a pouch-like structure near an organ or surrounding an organ. An abscess can be found in the folds of the intestines too. An abscess has to be treated immediately, or the infection may increase, and the viable tissue may turn into necrosed or non-viable condition. It is a bacterial type of infection commonly caused by Escherichia Coli.
Generally, the intestinal fistulae develop after intra-abdominal surgery but can also be formed independently because of any underlying chronic digestive problem. Both the intestinal fistula and the abscess are life-threatening. Due to them, the infectious exudate may seep into the bloodstream, carrying the infection all over the body. This state may lead the patient to death. They need to be taken care of as soon as possible. An early diagnosis of these anomalies can save a person’s life. The physician should observe the patients who have undergone abdominal surgery during the first week post-surgery. Most fistulae or abscesses form within the first week healing from the surgery and, if not treated in time, could be fatal.
What Are the Causes Behind the Formation of Intestinal Fistula and Abscess?
There can be various reasons behind the formation of these anomalies, such as an elevated count of white blood cells (WBCs), malnutrition, trauma to the abdomen, any underlying malignancy, hampered immunity, surgery in the abdomen, infection, inflammatory bowel diseases, and ulcers. These are the factors that may lead to the fistula or abscess.
What Are the Symptoms of Intestinal Fistula and Abscess?
In the external fistula, one may see discharge through the skin. Abdominal pain, fever, intestinal obstruction, rectal bleeding, diarrhea when the underlying disease worsens, lack of appetite, nausea, vomiting, and mass in the belly are some of the most observed symptoms of the anomalies.
How Are the Intestinal Fistula and Abscess Diagnosed?
-
Computed tomography (CT): It will generally be the primary test to be ordered. The abdomen and pelvis are checked through CT scans.
-
An X-Ray: It can also be useful to detect anomalies.
-
Magnetic resonance imaging (MRI): An image is obtained by magnetic resonance imaging.
-
Ultrasound: Sound waves are used here to create an image of the affected part of the body.
-
Blood test: Intra-abdominal abscess is tested pathologically to check white blood count (WBC), the presence of what type of bacteria, or any other abnormalities.
-
Physical examination: The physician will check for tenderness on palpation. Sometimes a mass can be felt in the abdomen.
How Are the Intestinal Fistula and Abscess Treated?
Treatment of Intestinal Fistula:
Fistulae may close independently and not need any treatment. They may close on their own when the infection is under control, the body absorbs enough nutrients, and gastric fluid is less than before. Sometimes the physician will treat the fistula by providing more nutrition, correcting the components of blood, managing acid-base balance in the body, reducing the exudate output coming from the fistula, taking care of the wound, controlling the infection, and preventing the sepsis.
Surgical intervention becomes necessary if the fistula does not close until the fifth week.
The amount of leakage through the fistula and the location decides the severity of the fistula, and the treatment plan depends on it.
Treatment of Intestinal Abscess:
Antibiotics are the primary treatment given to control abscesses. Antibiotics may fail to show their effect in an advanced stage of the abscess. In advanced stages, the physician gives sedatives or administers local anesthesia to the patient so that the patient does not feel any pain from the intervention. Then a needle is penetrated at the site of the abscess, and the abscess is drained.
Sometimes the abscess has to be drained surgically. Surgery may also repair the underlying situation that is causing an abscess. Also, a drainage catheter can be placed and removed when draining the abscess is over.
When Should We Seek Medical Help?
One should seek help as soon as the symptoms occur. If one has recently undergone surgery and also has comorbidities such as diabetes, then the patient should visit the physician even if the primary stage symptoms occur. If the patient has abdominal pain or pain at the site of surgery, fever, nausea, or vomiting, the healthcare facility should be visited. Serious situations like rectal bleeding, pus oozing out of the surgical site, and any bleeding if occurs, then the patient should be taken to the emergency unit.
Conclusion:
The intestinal fistula and abscess can be managed in various ways. After the treatment, long and proper care, and if other various management fails, surgical intervention is needed. Fistulae and abscesses can be life-threatening, but with early diagnosis, the patient can be saved.
