This is a pathological connection between two epithelial surfaces, usually lined with granulation tissue, but sometimes, epithelialized. Fistulae form when a chronic abscess bursts in two directions so establishing communication between two epithelial surfaces. Common types include fistulae between bladder and bowel, between parts of bowel, and between bowel and skin.
Fistulae may close spontaneously; they persist when they conduct the contents of one of the cavities due to obstruction of its normal outflow. Resolution requires eradication of the cause of the abscess or removal of the obstruction to emptying. Chronic inflammation, distal obstruction, foreign bodies, malignant tissue and epithelialization of the tract all inhibit fistula closure.
External intestinal fistulae are managed by protecting the skin, replacing fluid and electrolytes, parenteral nutrition, and when this fails, operation.
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