From the Guidelines
An enteroentero fistula is an abnormal connection between two separate segments of the intestine that does not always require surgery, especially if asymptomatic. This condition can be described as a pathological passage that allows intestinal contents to flow directly from one segment to another, bypassing the normal digestive pathway. Enteroentero fistulas can develop due to various conditions, with Crohn's disease being a common cause, as well as surgical complications, radiation therapy, diverticulitis, malignancies, and trauma 1. Patients with enteroentero fistulas may experience symptoms such as:
- Abdominal pain
- Diarrhea
- Malnutrition
- Weight loss Though some fistulas may be asymptomatic if they connect adjacent bowel segments without significant diversion of intestinal contents. According to expert consensus guidelines, enteroenteric fistulae are often asymptomatic and do not always require surgery 1. Diagnosis typically involves imaging studies like CT scans with oral contrast, MRI enterography, or barium studies that can demonstrate the abnormal connection. Treatment depends on the underlying cause, location, and severity of symptoms, with options including conservative management with nutritional support, antibiotics for infections, and medications to control underlying conditions like Crohn's disease, or surgical intervention involving resection of the affected bowel segments and primary anastomosis to restore normal intestinal continuity.
From the Research
Definition of Enteroentero Fistula
- An enteroentero fistula, also known as an entero-enteric fistula, is an abnormal connection between two parts of the intestine 2.
- It is a type of fistula that forms between two epithelial surfaces, in this case, between two segments of the bowel 3.
Causes and Symptoms
- Enteroentero fistulas can occur as a complication of Crohn's disease, which is a type of inflammatory bowel disease [(2,4)].
- They can also be caused by other factors such as surgical intervention, foreign bodies, bowel diverticula, malignancy, radiation, and infection 3.
- Symptoms of enteroentero fistulas can be non-specific and may include abdominal pain, diarrhea, and weight loss [(2,4)].
Diagnosis and Treatment
- Diagnosis of enteroentero fistulas can be made using radiological examinations such as computed tomography (CT) scans and magnetic resonance imaging (MRI) 3.
- Treatment of enteroentero fistulas depends on the underlying cause and may involve surgical intervention, medical management, or a combination of both [(2,4)].
- Conservative surgical approaches, such as resection of the involved bowel segment and conservation of the "victim" segment, may be preferred in some cases 4.
Management and Outcome
- Management of enteroentero fistulas requires a multidisciplinary approach and may involve optimizing nutritional status, delineating fistulous tract anatomy, and managing the underlying disease 3.
- Somatostatin analogues have been used in the treatment of enterocutaneous fistulas, which are abnormal connections between the skin and gastrointestinal tract, and have been shown to decrease the time to closure of fistulas and duration of hospital stay 5.