This document summarizes key points about gastrointestinal fistulas: Fistulas are abnormal connections between epithelial surfaces, often between the GI tract and other organs or the skin. GI fistulas can be internal or external. High-output fistulas produce over 500mL/day of output and carry higher risks. Treatment involves recognition, stabilization, investigation to determine the nature and location of the fistula, and definitive treatment such as surgery or medical management.

1. Gastro-Intestinal Fistula
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2. • Fistulas are abnormal communications between
two epithelial-lined surfaces
• Gastrointestinal (GI) fistulas represent abnormal
ductlike communications between the gut and
another epithelial-lined surface
– organ system
– skin surface
– GI tract itself

4. • The majority of external (cutaneous)
fistulas represent a complication of recent
abdominal surgery
• The leading causes of internal fistulas
– Crohn disease
– Diverticulitis
– Malignancy
– Complication of treatment

5. • F – Foreign Body
• R – Radiation
• I – IBD / Infection
• E – Epithelialized tract
• N – Neoplasm
• D – Distal Obstruction
• S – Segment (>2cm)

6. • High output fistula are from upper GI tract
• High-output GI fistula discharge more than
500ml/day
• High-output pancreatic fistula is one which
produces more than 200 ml/day
• High output fistula
– more serious metabolic disturbances
– higher mortality rates

7. • Spontaneous closure
– bowel continuity is maintained
– no abscess
– adjacent bowel is healthy
– no distal obstruction
– fistula tract is not epithelialized
– not more than 2 cm in length
– bowel defect is less than 1 cm in diameter
• Least likely to close with non-operative therapy
– gastric
– lateral duodenal
– ligament of Treitz
– ileal fistula

8. • Nutritional Support
– Minerals, vitamins, electrolytes
– Caloric intake (35-45 cal/kg/day)
– Protein (1.5-1.75 gm/kg/day)
– TPN

9. • Recognition and Stabilization
– fluid resuscitation, electrolytes, acid/base balance,
control of sepsis, local wound care, nutritional support
• Investigation and Assessment
– radiological
– source, nature of tract, bowel continuity, obstruction,
adjacent bowel, abscess
• Definitive Treatment
– somatostatin and nutritional support, surgical
resection +/- diversion