In relation to an external environment:

• external

• internal.

On a structure:

• tubular – with the expressly expressed which, as a rule, deported granulations (an exception is ephithelial coccygeal motions);

• lip-form – practically without a fistulose channel with the direct transition of epithelium of mucous membrane declivous organ| on a skin (opening declivous organ in an external environment).

Depending on character of tissues, covering a fistulose channel|:

• granulating

• epithelizated

In grain excretions: milk, salivary, excrement, festering, liquoric, bilious, intestinal, urinal, mucous.

Etiology and pathogenesis

Innate fistula develops because of persistence of some embryonic epithelial formation which developed in a norm (fistulas of neck, belly-button, coccyx). In one cases they are formed initially (at a complete nonunion). At a partial nonunion a secret is saved in into formation. A cyst is formed. After the critical increase of pressure in the cavity of cyst (accumulation of secret, suppuration) there is a breach outside. Fistula is thus formed.

Purchased fistulas arise up at the unfavorable of pathological process:

- inflammation, especially, festering;

- presence of extraneous bodies (ligatures)

- tumour (disintegration or germination in nearby organs and tissues)

- trauma and operation (insolvency of guy-sutures)

- violation of trophism of tissues, necrosis, unremote sequestrum

Thus simultaneously there is destruction of tissues, and increase of intrinsic tissue pressure (due to the limited accumulation leaving to rot, detritus, secret). Durability and resistance of tissues and saved liquid diminishes breaks through outside or in a perigastrium (organ)

Factors which hinder cicatrization of a fistula:

1. Permanent expiration of secret of organon a fistulose channel.

2. Irritating action chemically of active secrets on granulation (intestinal, gastric and pancreatitis fistulas)

3. With sleeping not compartments festering-necrotizing process, not remote sequester. Irritating action of microbial toxins and products of disintegration or oppressing of growth of granulations. Permanent expiration of excaudate.

At epithelial fistulas of proceeding in integrity of covers warns possibility of development of infection. At granulating fistulas, at destruction of granulations and violation of their normal growth| there are terms for penetration of toxins and microbes in circumferential tissues. It conduces to development of reactive inflammation, plenty of scars round a channel and at weakening of organism - festering infection.

Clinic. Complaints about discomfort, pain, weakness predefined localization, character of excretions and its amount and parafunction the proper organ. Objectively: natively is the external opening of different diameter and form, excretions (different character and amount), irritation of skin is possible, dermatitis as a result of irritating action of digestive organs juices, dense edema of surrounding tissues (up to elephantiasis – at urinary fistulas).

General symptoms are festering intoxication (at an insufficient outflow on festering fistulas), disorders of albuminous, water-salt exchange at high fistula of gastroenteric highway, parafunction organ at flowing in him of unusual him secrets (meal in bronchial tubes at bronchoesophageal fistula|), second infecting through a fistula.

A course is protracted without a tendency to independent cicatrization of epithelial fisulas (granulating fistula can wilfully heal at stopping of action of irritating factor).

Diagnostics:

1. Account of complaints, anamnesis, amount| and character| of excretions

2. Fistulographia – for clarification of structure

3. Chemical research of selection is maintenance of НСl

4. Tests with dyes for clarification of connection of fistula with certain structures

Treatment. The basic method of treatment is operative. Its basic principle is carving within the limits of healthy tissues of fistula motion and liquidation of causal factor. Examples:

1. excision with pathological embryonic formation

2. resection of bowel which carries fistula

3. resection of part of pancreas which supports the fistula

4. delete of sequester or resection of a bone

5. delete of foreign body (ligatures)

6. delete of necrotic tissues

The special value has a care of skin round the external opening. For protecting of it from the aggressive action| of liquid which is selected through the fistula, often use paste of Lassar. At intestinal fistulas use a colostomy bag. At incomplete fistula of gastroenteric highway use obstructers.

In the plan of preparation to the operation is treatment of a fistula. General treatment (correction of metabolic disorders).

ARTIFICIAL fistulas

Some authors (Э.Н. Vantsyan, 1990) consider that channel, created operative a way, for taking of secret or excrete to name fistula is not rite.

Classification

1. After attitude toward an external environment|Wednesday|:

• external or with т about a mcode and (lat. stoma is opening) are openings which connects the cavity of organ with an external environment. Examples – gastrostomy, colostomy, anus praeter naturalis;

• internal or anastomoses are wide enough inter organ connections at which the mucous membrane of one organ directl passes to the mucous membrane of other organ. Example – gastroenteroanastomisis. illeotransfersoanastomosis.

2. Depending on the purpose of forming:

• temporal (трахеостома| at craniocerebral traumas|maim|, сигмостома| at operations concerning the traumas|maim| of rectum|fatend|

• permanent (at impossibility to remove reason which compels to form such fistula, – sigmostoma at the inoperable tumour of rectosigmoid transition or impossibility of proceeding in a natural arcade).

A purpose is proceeding in the function of organ (arcade of meal| on a gastroenteric highway, breathing – tracheostoma)

• taking of content declivous to the organ (cystotome at the trauma of urethra, sigmostoma at the trauma of rectum|).

Closing of artificial fistula is conducted on general rules by treatments of fistulas.

Temporal tubular fistulas can be closed independently at stopping of selection of content through them.