Ligature seam. Fistula after surgery: treatment and consequences

Postoperative fistula doctors consider one of the complications after surgery.

The first action of the patient is to notify the attending physician. A postoperative fistula is easily recognizable, it is simply a hole in the skin from which fluid oozes.

Waiting for self-healing of the wound is not worth it in any case.

Causes of postoperative fistula

Doctors with the help of probes will determine, as well as its connection with surrounding organs.

With labial fistulas, in most cases, surgical treatment is resorted to, since conservative treatment in this case is futile.

tubular fistula may in some cases close itself, but this will happen only after the cessation of secretions.

Epithelized fistulas and their treatment

Epithelialized fistulas are already formed, in fact, they are covered with skin inside and cannot close on their own, therefore, the treatment of epithelialized fistulas can only be carried out with the help of surgical intervention, while the pathological focus that initiated the fistula formation is eliminated, in addition, the fistulous tract and the epithelium covering its surface are excised .

Each operation is a serious risk for the body. Currently, doctors are trying to carry out most surgical interventions with minimal suturing of the wound area. However, even with careful observance of all the rules for caring for the operating area, complications such as ligature fistulas may occur. According to statistics, every tenth patient of working age and every fifth pensioner face them. That is why it is necessary to know the first symptoms of the onset of the disease, as well as pay great attention to the rules of prevention. So you can protect yourself and your loved ones from the development of such complications.

What is a ligature fistula

A ligature fistula is an inflammatory cavity formed after surgery, in which there are purulent masses. Almost all surgical procedures involve damage to the patient's soft tissues. To close the resulting defect and ensure the immobility of the edges of the wound, doctors use special sutures. The threads that are superimposed on the damaged area are called ligatures. Unfortunately, such an intervention is often complicated by the addition of an inflammatory process.

How long after surgery does the disease appear?

A ligature fistula can develop in the early postoperative period (in the first seven to ten days after the surgical intervention). Moreover, its occurrence is associated with infection of the suture material. If the fistula is formed in the late postoperative period (on the eleventh day and later), then these are the consequences of defects in care and dressing.

What types of surgical intervention provoke the development of a ligature fistula

Such a pathology may occur against the background of the following operations:

1. Appendectomy. This is a surgical procedure to remove the appendix of the caecum, which is located in the right side of the abdomen just above the pubis.
2. A caesarean section is a procedure for removing a baby from the mother's body. In this case, the incision is located directly above the pubis, and doctors sequentially dissect the skin, fatty tissue, muscles and uterus. The danger of developing a fistula after this operation is that the pus directly enters the reproductive organs and can cause infertility.
3. Mammoplasty is a surgical intervention aimed at increasing the size of the breast. Through the incision, which is located under the breast, in the area of ​​the nipple or armpit, a silicone implant is inserted.
4. Episiotomy is an operation to cut the perineum. Used in difficult childbirth (multiple pregnancy, large child).
5. Nephrectomy is a surgical procedure in which the kidney is removed. In this case, the incision is located in the lumbar region, as a result of which the wound is almost always subjected to a greater load.

Photo gallery: the location of the seams after various operations

A caesarean section is one of the most difficult operations in which a large incision is usually made.
With mammoplasty, a ligature fistula is often formed under the breast. After surgery to remove the appendix, the suture is located to the right of the midline

What is ligature infiltrate and ligature granuloma

A ligature granuloma is an inflamed area of ​​tissue that is limited from the surrounding organs by a protective shaft. Its formation is associated with a massive growth of the connective tissue substance, which fills the entire space of the defect.

Ligature infiltrate is a cavity inside which altered cells and inflammatory fluid are located. And it is also possible the presence of pus, blood and other foreign matter.

Causes of the appearance of a ligature fistula

A similar pathology develops after bacterial microorganisms enter the wound. Most often it is staphylococcus, streptococcus or Pseudomonas aeruginosa. However, the following factors from the organism and the environment also take part in the formation of the ligature fistula:

• hypothermia or overheating in the sun;
• infection of the suture material;
• insufficient disinfection of the skin during the operation;
• transferred bacterial or viral diseases (colds, SARS);
• extremely low or too high body weight;
• the presence of malignant or benign formations;
• an allergic reaction to the components of the threads;
• advanced age of the patient;
• condition after childbirth;
• malnutrition with a lack of proteins or fats;
• other injuries.

How does the formation of such a pathology manifest itself?

The symptomatic picture of the development of a ligature fistula is quite typical and does not differ in a special variety of signs. A few days or weeks after the operation, the victim begins to feel pain in the wound area. Often it is accompanied by swelling and redness: the seam looks swollen, the threads change color. The skin becomes hot and bright pink, leaving a white imprint when pressed.

After a few days, hemorrhages appear in the area of ​​​​damage in the form of large and small bruises. Along with this, the nature of the discharge from the wound changes: from yellowish, colorless or bloody, it becomes purulent. In this case, the color changes to green, and an unpleasant odor arises, which is provided by existing bacteria. Patients complain of severe soreness and an increase in the amount of discharge with pressure. The skin near the affected area acquires a dense edema, becomes hot and tense, the sutures can erupt and injure the surrounding tissues.

Chronic and asymptomatic course of such a pathology is quite rare. Most often it occurs in older people, which is associated with a violation of the rate of metabolic processes in the body.

With a more severe course of the disease, the symptoms of general intoxication gradually increase:

• nausea and vomiting not associated with meals;
• and dizziness;
• loss of appetite;
• rise in body temperature to 37–40 degrees;
• decrease in working capacity;
• increased fatigue;
• sleep disturbances due to pain and frequent awakenings;
• nervousness, irritability and other changes in mental state.

In some cases, there is a tear of the purulent channel and self-cleansing of the wound. So you can see the formed passage - fistula. At the last stage, the formation of such an ailment can be complicated by the addition of massive bleeding from damaged vessels. The patient's condition is rapidly deteriorating, he loses consciousness and needs immediate resuscitation.

Methods for diagnosing a disease

An experienced doctor will be able to suspect the development of a ligature fistula in a patient at a glance. To do this, he only needs to examine the area of ​​damage and assess the condition of the seams. However, in order to prescribe treatment, it is necessary to obtain more complete information about the size and course of the fistula, as well as find out which microflora caused its development.

What treatments help get rid of the disease

Ligature fistula is a pathology that is prone to frequent recurrence. That is why therapy lasts an extremely long time and requires a responsible attitude not only from the doctor, but also from the patient himself. At the initial stage, doctors prescribe local medications for external wound treatment. In this case, the patient needs to appear every two days for dressings or show the suture to the attending physician at least once a week (when it is not possible to constantly travel to the hospital). If the pathological process continues to progress, more general drugs are prescribed that affect the state of the whole organism. Surgical intervention is performed in the absence of positive dynamics from conservative treatment within one and a half to two weeks.

Do not forget that with a second operation there is also a risk of a ligature fistula. It is necessary to care for the wound according to the same principles as for the primary surgical intervention.

Medical therapy for pathology

Treatment of a ligature fistula with conservative means consists in the use of local and general pharmaceutical preparations. They allow not only to get rid of the symptoms of the disease, but also to completely eliminate the cause that provoked the development of the disease.

Remember that without medical prescriptions, the use of any medication is strictly prohibited. In my practice, I have encountered a patient who independently began to take antibacterial agents without reading the contents of the instructions. He also suffered from cardiovascular disease, for which there is a rather limited list of drugs that can be used. In an effort to recover faster, the patient also repeatedly exceeded the dosage of the antibacterial drug. This led to the development of serious complications: the man fell into a coma, from which he had to be taken out by the doctors of the intensive care unit. The situation ended happily, but the victim became deeply disabled as a result of his experiments. That is why doctors advise very carefully approaching the choice of drugs.

Means for local treatment of ligature fistula:

1. Antiseptic solutions are designed to treat the wound surface. They allow not only to remove the remnants of fat, blood, ichor and purulent secretions from the skin, but also kill most harmful microbes. For this purpose, Miramistin, Chlorhexidine, hydrogen peroxide, Furacilin, potassium permanganate are most often used.
2. Healing ointments that improve blood circulation and help accelerate regeneration processes. The most common means: Bepanten, Rescuer, Dexpanthenol, Pantoderm.
3. Anti-inflammatory gels reduce the severity of edema, allow you to fight itching and relieve pain. Most often used: Diclofenac, Nise, Nimesulide, Ibuprofen, Ketorol, Ketorolac.

Photo gallery: preparations for local wound treatment

Chlorhexidine helps to disinfect the wound surface
Dexpanthenol accelerates recovery processes Diclofenac is an anti-inflammatory drug with analgesic effect

Medications for general therapy:

1. Antibiotics have a pronounced antimicrobial activity and cause the death of all bacteria. For this purpose, use: Klaforan, Tetracycline, Vibramycin, Keiten, Augmentin, Unazine, Azlocillin, Zinnat, Aztreonam, Imipenem, Vancocin, Rondomycin.
2. Steroid anti-inflammatory drugs are hormones that reduce the effect of bacterial toxins on the body, relieve redness and swelling of soft tissues. It is permissible to use Hydrocortisone, Cortef, Laticort, Dexons.
3. Vitamin and mineral complexes accelerate healing processes and restore the body's need for certain substances. Most often used: Complivit, Calcium D3-Nycomed, Aevit, Vitrum, Supradin.

Photo gallery: drugs for systemic effects on the body

Augmentin is a broad spectrum antibiotic that kills bacteria. Cortef helps relieve inflammation Vitrum contains all the mineral elements necessary for the body

Surgical treatment of ligature fistula

Conservative therapy is not always an effective technique for such a disease. If the disease progresses steadily, doctors decide on the need for repeated surgical intervention. It is carried out under the following conditions:

• accession of purulent complications;
• a sharp deterioration in the patient's condition;
• lack of effect from conservative therapy;
• cutting through the suture.

Contraindications for surgery:

• the need to stabilize the condition of the victim;
• too old or too young;
• acute allergic reaction to the components of anesthesia.

The operation is carried out in several stages:

1. Doctors anesthetize the area of ​​the proposed intervention. The choice of anesthesia technique (general or local) depends on the location of the suture and its size. The surgical field is treated with alcohol and iodine solution.
2. Using a scalpel and tweezers, the old suture material is removed, while expanding the incision area. Next, doctors study the condition of the wound, the presence of purulent streaks and sores, if necessary, adds a dye (this allows you to determine the course of the fistula).
3. Using vacuum suction, surgeons remove accumulations of blood, lymph fluid, and areas of dead tissue. The formed fistula is excised with a scalpel.
4. Using another suture material, the formed wound is closed. If necessary, a thin rubber tube is placed in one of its corners - drainage, through which the contents flow. The sutures are closed with a sterile dressing with a healing ointment.

How to properly care for the place of suppuration

To avoid the attachment of a secondary infection and protect your body from the development of purulent complications, it is necessary to monitor the cleanliness of the wound. The first few days after the operation, the dressing and processing of the suture is done by a nurse under the supervision of a doctor. But in some cases, the patient has to take care of the surgical wound on his own from the very beginning. That is why the following processing steps must be observed:

1. Wash your hands with soap and water, then dry them with paper towels (this will help minimize bacteria). Disinfect your palms and fingers with an antiseptic.
2. Treat the skin around the wound with water and cotton pads. Alcohol-free gels can be used. If necessary, also wipe the skin with an antiseptic without touching the seams.
3. Carefully remove the bandage. It is necessary to do this with soft and unsharp movements, as jerks can damage surrounding tissues. If soaking with ichor and blood has occurred, it is allowed to soak the bandage in an antiseptic or in plain water.
4. Using a small gauze swab, evenly treat the surface of the seam. Try to remove dirt and dried blood. Continue rinsing until the wound is clear.
5. Apply a bandage with the ointment prescribed by the doctor and gently wrap it with an elastic bandage. At the same time, try not to overtighten the soft tissue.

What is strictly forbidden to do during the rehabilitation period:

1. Visit baths or saunas, bathe in a hot tub. Steam softens the tissues around the seam, as a result of which the threads are cut through and an even deeper fistula is formed. For the same reason, you can not apply a heating pad to the affected area.
2. Swim in public ponds, rivers and quarries. That water does not undergo special treatment and is the source of many harmful bacteria that penetrate even through the applied bandage. Swimming in pools is limited due to the presence of bleach, which disrupts the healing process of soft tissues.
3. Use alcohol-containing solutions for wound treatment without medical prescription. Such drugs not only kill bacteria, but also damage the smallest vessels, causing bleeding. That is why their use is strictly limited.

Video: dressing and wound treatment technique

Features of therapy of ligature fistula after various types of operations

Often, such a complication occurs after natural and artificial childbirth (caesarean section) or episiotomy. During pregnancy, a woman's body is under the influence of hormones, as a result of which soft tissues lose their former elasticity and undergo mechanical stretching and tearing.

According to statistics, every third childbirth ends with suturing the damaged perineum.

A feature of the treatment of this condition is the impossibility of using many of the usual medications, as they enter breast milk and can be transmitted to a newborn child, negatively affecting the state of his body. That is why doctors mainly use local therapy: the suture must be treated with an antiseptic solution several times a day, and the woman also needs to maintain the cleanliness of the surrounding tissues. Topical preparations do not penetrate into breast milk and do not affect the condition of the child. If the pathological process progresses, doctors prescribe antibiotics that have a minimal effect on the newborn: Amoxicillin, Erythromycin, Cefatoxime.

Treatment forecasts and possible complications of such a pathology

Soft tissue healing is a long and not always predictable process that can face a number of really serious complications. The duration of the recovery period largely depends on the age of the patient and his state of health. In children and young people, the ligature fistula heals within two weeks to three months, while in the elderly this period can take up to six months. Patients with diabetes mellitus, hypertension, cardiovascular diseases have a lower rate of soft tissue healing, as a result of which they have a significantly increased risk of developing secondary complications.

Important in the treatment of ligature fistula is strict adherence to hygiene and the rules for the treatment of postoperative wounds. While working in the department of purulent surgery, I had a chance to encounter a man who developed a serious complication in the form of attachment of bacterial microorganisms to the area of ​​the postoperative incision. As it turned out, the victim did not clean his hands before changing the bandage, and also periodically sealed it with a rough plaster. When it was separated from the skin, tissues were constantly traumatized, which complicated the healing process. The man was operated on and all elements of pus were removed, which greatly alleviated his condition.

What complications can occur in patients with ligature fistula:

1. abscess formation. This pathological formation is a massive accumulation of pus in the soft tissues, which is limited to the capsule. An abscess develops gradually: edema begins to form in the wound area, pain increases sharply. After a couple of days, a motionless red elevation above the skin surface is formed, which has a densely elastic consistency. When probing, softening is observed in its middle, the boundaries of which increase with time. Treatment of an abscess is carried out by opening it and excising the capsule. In addition, doctors prescribe antibiotic therapy.
2. The development of phlegmon. Unlike an abscess, this accumulation of pus has no boundaries in the soft tissues and can spread further along the course of the fatty tissue. Phlegmon melts nearby vessels and nerves, as a result of which the blood supply to the most important organs and systems is disrupted. Its danger lies in the fact that often the formation lies deep in the tissues, and it is quite difficult to detect it. Edema and redness can form only 4-7 days from the onset of the disease. You can get rid of phlegmon only with the help of surgery and the further intake of antibacterial drugs.
3. Blood poisoning. One of the most dangerous complications that all doctors fear is sepsis. When bacteria enter the systemic circulation from the area of ​​the ligature fistula, a cascade of pathological inflammatory reactions is formed, during which microbes enter all internal organs. As a result, their functioning is disrupted: the heart, kidneys and brain suffer the most. And also the leading mechanism of this condition is the thickening of the blood - it cannot normally pass through the vascular bed. Treatment of this pathology is carried out in the intensive care unit and intensive care with the help of detoxification, antibacterial and anti-inflammatory drugs.
4. The development of a scar at the location of the ligature fistula. Usually, the entire defect is filled with connective tissue, which has a different structure than skin and muscles. The scar can be quite rough and even interfere with certain activities. In order to prevent this condition, doctors use physiotherapy and healing ointments and gels.

Photo gallery: possible complications of the disease

The phlegmon of the leg can be located very deep and do not give other symptoms, except for edema. An abscess is a purulent formation with a capsule A scar is an overgrowth of connective tissue

How to prevent the development of a ligature fistula

Unfortunately, despite all the efforts of doctors, the problem of infection penetration into the surgical wound still remains unresolved. In order to prevent this pathological condition at an early stage, recommendations for individual and group prevention are developed annually. As part of the latter, practicing professors of medical universities organize lectures and open seminars on the period of rehabilitation of patients after surgery. There, anyone can get information not only about care, but also about recovery procedures.

While studying at the Department of Traumatology, I had the opportunity to participate in an event dedicated to the problem of the occurrence of a ligature fistula in the early and late postoperative period. To get the most detailed information, the doctors presented illustrative cases from their practice: a selection of patients aged twenty to eighty years who were not lucky enough to encounter such an ailment. In the course of the study, all victims were asked to fill out questionnaires containing questions regarding lifestyle, diet, and hygiene measures taken to treat the wound. As it turned out after analyzing the data obtained, about 20% of patients continued to abuse alcohol and did not follow the rules for cooking, 5% missed taking the necessary pills, and 40% performed bandaging at home, which increased the risk of infection from the environment. Doctors came to the conclusion that the vast majority of patients violated the rules for conducting the recovery period: this affected the formation of a postoperative fistula. Based on the data obtained, we have developed universal recommendations for the prevention of the development of such an ailment, the use of which helps to reduce the risk of its occurrence by several times.

How to protect your body from the formation of pathology in the postoperative period:

1. Long before planning a surgical intervention (if it is not an emergency), it is necessary to check for an allergic reaction to the components of the suture material. This can be done in the same hospital where the operation will be performed. To do this, ask the surgeon for samples of the alleged threads and take them to the allergological laboratory. There, the doctor, using cutaneous or intradermal tests, will reveal the presence of a pathological reaction. With redness, swelling and swelling of the skin, it is better to refuse to use this type of material. Currently, there are a huge number of suture threads: one of them is sure to suit you.
   The application test allows you to detect the allergen
2. Try to avoid stress and neuropsychic upheavals. During the recovery period of the body after surgery, even slight anxiety can cause a deterioration in the condition. It has been proven that during tension and stress, the internal glands of a person secrete hormones that slow down the processes of rehabilitation and healing of tissues.
3. Follow hygiene. Most opportunistic bacteria live on the skin even in a healthy person. Under normal conditions, with intact tissue integrity, they cannot enter the bloodstream and cause an infectious process. But in the postoperative period, the body becomes especially vulnerable, and the wound is the entrance gate for bacteria. That is why it is so important to keep clean surrounding tissues. It is recommended to wear loose-fitting clothing made from natural materials that will not cover the site of the postoperative incision or injure it in any way. In the morning and evening, it is necessary to treat the skin with water and detergents, while not touching the bandage.
   Antiseptic gel removes germs from the surface of the skin
4. Give up physical activity. Prolonged lifting and carrying of weights or exercising in the gym can cause the suture material to cut through the soft tissues, as a result of which the wound will open. This will not only increase the risk of infection, but may also lead to a second operation. That is why doctors forbid playing sports and lifting loads of more than one kilogram for several months after surgery. Once a stable scar is formed, you can return to unlimited training again.
5. In the period before and after the operation, try to adhere to proper nutrition. Popular vegetarian and vegan diets with no animal protein reduce the rate of soft tissue healing and lengthen the recovery process. During the rehabilitation period, the body needs to receive fats and carbohydrates in large quantities, and the calorie content of the diet should not be less than 2500-2700 units. Doctors recommend giving up fast food, fast food, carbonated drinks and packaged juices, as well as sweets. These foods slow down the body's metabolism and can adversely affect wound healing. Give preference to vegetables, fruits, berries, lean meat and fish, as well as cereals and cereals. You can restore the amount of protein and calcium in the body with the help of dairy products and special vitamin and mineral complexes.
   Dairy products are necessary for the nutrition of patients in the postoperative period

Postoperative ligature fistula is a common situation in surgical practice. If you find such a defect, you should not worry and worry once again: the modern system of medical care has long provided for the occurrence of such a situation. When the first signs of the development of the disease appear, do not self-medicate: it will be much more effective and reliable to contact the doctor who performed the operation. He will be able to accurately determine the cause of the ligature fistula and offer effective ways to deal with such a problem.

A fistula is a pathological channel that connects a hollow organ and the external environment or two hollow organs. Most often appearsfistula after surgery. Treatment of this formation is quite long and painful. That is why the patient must strictly adhere to the doctor's instructions.

The fistula is a hollow neoplasm, which in its appearance resembles a deep wound. In accordance with the characteristics of the development of neoplasms, they can be:

• labial. AT this case there is an fusion of fistulas and skin, as well as muscle tissue. Removal of fistulas is carried out using a surgical method.
• Complete. It is characterized by the presence of two exits, which makes it possible to most effectively combat the inflammatory process.
• tubular. It is a fully formed channel, from which there is a constant discharge of feces, pus and mucus.
• Incomplete. The neoplasm is characterized by one exit, the location of which is the abdominal cavity. With this type of fistula, pathogenic microflora multiplies, and inflammation also aggravates.
• Granulating. With this type of fistula, granulation tissue is formed. With this pathological process, swelling and hyperemia are often observed.

About, what is a fistula after surgeryonly the doctor knows. After an appropriate diagnosis, a specialist will be able to determine the type of formation, which will positively affect the treatment process.

Reasons for the appearance

Postoperative fistulasmay develop for a variety of reasons. Most often, pathology is observed against the background of an infectious process that enters the human body through sutures and wounds. After a surgical intervention, the human body may reject the thread, which is explained by intolerance to its components. Against this background, it appearspostoperative fistula. The development of neoplasms can be diagnosed in the presence of other provoking factors, which include:

• High immune reactivity of the body;
• Elderly age;
• Chronic specific infection;
• hospital infection;
• Oncological diseases.

If vitamins and minerals enter the human body in insufficient quantities, this leads to the formation of fistulas.. Postoperative fistula, treatmentwhich is very long, appears in violation of the metabolism - diabetes, metabolic syndrome, obesity.

Before, how to treat a fistula after surgery, it is necessary to determine the cause of its occurrence. Therapy of pathology should be directed to its elimination.

Symptoms

Fistulas after surgerycharacterized by the presence of certain features. Initially, the appearance of a seal on the skin around the size is observed. There is pain on palpation. In some patients, the appearance of pronounced tubercles is diagnosed, which is used to secrete the infiltrate. Reddening of the skin may be observed at the site of infection of the scar.

The pathological process is often accompanied by a sharp increase in body temperature. This is due to the course of the inflammatory process in the human body. It is impossible to bring down the temperature to a normal value. Fistulas are accompanied by a purulent process. With untimely treatment of pathology, the size of the abscess increases significantly. In patients, there is a tightening of the fistulous opening for a certain period. This is followed by the development of inflammation.

Fistulas are characterized by the presence of certain signs. When they appear, patients are advised to immediately consult a doctor. Timely treatment of the disease will eliminate the possibility of side effects.

Features of therapy

Fistula treatment after surgeryin most cases requires surgical intervention. Initially, the surgical field is treated with special antiseptic solutions, which will eliminate the possibility of infection. Surgery requires the use of local therapy. In order for the surgeon to find the course of the fistula as quickly as possible, a dye solution is introduced into it.

The surgeon removes the fistula with a scalpel. All other actions of specialists are aimed at stopping bleeding. After that, it is recommended to wash the wound with a solution with an antiseptic effect. Postoperative sutures are applied to the wound. In this case, it is recommended to use active drainage.

The treatment of postoperative fistulas requires the use of not only surgical intervention, but also appropriate medications. In most cases, patients are prescribed antibiotics and anti-inflammatory drugs:

• Diclofenac;
• Nimesila;
• Dicloberla.

In order to speed up the healing process of wounds, the use of Troxevasin or Methyluracil ointment is recommended. It is also recommended to use preparations that are of plant origin - aloe, sea buckthorn oil, etc.

That, how long does it take for a fistula to heal after surgerydirectly depends on the characteristics of the rehabilitation period. Patients are recommended daily hygiene procedures in the area of ​​the operation. The patient is advised to disinfect the sutures daily with the help of special preparations. The patient's diet should be rich in fiber, which will eliminate the possibility of constipation. In the postoperative period, it is recommended to exclude heavy physical exertion. Prolonged work in a sitting position should be abandoned for three months.

How does it appear fistula after surgery, what is itonly the doctor knows. That is why, if neoplasms occur, it is necessary to seek help from a doctor who will determine the type of formation and prescribe rational therapy.

Fistula - what is it? You will find the answer to the question posed in the materials of the presented article. In addition, we will tell you about why such a pathological condition occurs, as well as what symptoms it is accompanied by and how you can get rid of it.

General information

Fistula - what is this deviation? In medical practice, such a pathological phenomenon is often called a fistula. This word is derived from the Latin "fistula" and literally means "tube". In other words, a fistula is a kind of channel that connects a tumor or abscess to the surface or two cavities (two organs) to each other.

Appearance

Fistula - what is this pathological phenomenon, what does it look like? As a rule, such a fistula looks like a rather narrow canal, which is lined with an epithelial layer and is accompanied by characteristic secretions.

Main reasons

Why does a fistula develop? Reasons for this deviation include the following:

• After the cessation of any inflammation, pus usually comes out. Moreover, the channel through which it flows out heals painlessly in the future. However, in some cases (for example, if the inflammatory process has not been completely eliminated), there continues to be a cavity with infection in the depths of the tissues (sometimes even with a dead bone area), and therefore the “tube” does not grow together, but forms a purulent fistula.
• Fistulas can arise from the roots of the tooth (in chronic periodontitis), passing through the gum and jaw.
• If, after the blind, fragments of bullets and bones were not removed in time, then suppuration also forms next to them, which leads to the development of fistulas.
• This deviation is often formed after surgical operations with suppuration of sutures next to ligatures (that is, threads used to tie internal tissues, blood vessels, etc.). In this case, there is a ligature fistula.

Types of fistulas by location

Before proceeding with the treatment of such a deviation, its type should be determined. This is not difficult to do, since this classification depends primarily on the location:

• Gastric fistula. This pathology most often occurs after surgical operations (for example, after resection of the main digestive organ).
• Rectal fistula.
• Fistula anorectal. Such a deviation is characterized by a pathological canal leading from the anus (or rectum) to the skin.
• Fistula pararectal. Runs outward from the anal crypt to the skin.
• Rectovaginal fistula. With this disease, the rectovaginal septum is damaged.
• Duodenal, or so-called intestinal fistulas. This is the external canal coming from the duodenum.
• Fistula bronchial. Such a deviation is accompanied by pathological communication of the lumen of the bronchus with the pleural cavity.

Types of fistulas due to the appearance

Absolutely any fistula (photos of these deviations are presented in this article) can be classified as follows:

• Acquired. In other words, such a phenomenon occurs as a result of suppuration (for example, a fistula of a tooth with either serious diseases such as osteomyelitis or tuberculosis.
• Congenital. In this case, fistulas arise from malformations (on the navel, neck, etc.)
• Created artificially. Such deviations are formed after surgical intervention (for example, ligature fistula).

Types of fistulas by contact with the environment

In this case, such a pathological phenomenon may be:

• External, that is, go directly to the skin (for example, a fistula of the rectum).
• Internal, that is, not communicate with the external environment in any way, but connect only adjacent cavities (for example, bronchoesophageal fistula).

Types of fistulas according to the nature of the secret that stands out from them

These fistulas include:

• purulent;
• mucous membranes;
• bile;
• urinary;
• feces, etc.

The main symptoms of the disease

The clinical picture of such a pathology depends, first of all, on the location of the fistulas and the cause of their appearance.

Thus, the main symptom of this disease (external) is a hole in the skin, from which fluid is released. By the way, the appearance of a fistula may be preceded by either trauma to this area, or inflammation of nearby tissues and organs, or surgery.

As for internal fistulas, most often they appear as a result of complications of chronic or acute diseases. For example, bile is often formed due to obstruction of the ducts by a stone. In this case, the symptoms of the deviation depend on the amount of bile that is secreted into the abdominal cavity. So, the patient may feel severe pain and pronounced disorders of the digestive tract.

Bronchoesophageal fistulas are often complicated by food entering the tracheobronchial tree. It is this fact that leads to the development of aspiration pneumonia or bronchitis with the corresponding symptoms.

A fistula of the rectum can be identified by the following symptoms:

• The presence of a barely noticeable hole in the anus (on the skin). In this case, the patient may experience copious discharge of pus, and therefore he is forced to constantly wear a pad and take a shower regularly.
• Aching pain in the anus. As a rule, such sensations are most intense during a bowel movement, and after they noticeably subside.

A fistula on the gum is determined by such signs as:

• severe tooth mobility;
• toothache that gets worse when touched
• purulent discharge.

Diagnostic methods

If you observe at least one of the above signs in yourself, then you need to immediately consult a doctor for a correct diagnosis. It should be noted that specialists do not have any special difficulties in diagnosing such a deviation. After all, it is based on collecting an anamnesis, studying the characteristic complaints of patients, the type of fistula, analyzing the composition and amount of fluid released, as well as changing the functioning of the affected organs.

To clarify the direction and length of the fistulous canal, as well as its direct connection with the focus, probing and radiography are often used in conjunction with the introduction of a contrast agent into the passage.

By the way, you can clarify the diagnosis of "gastric fistula" with the help of studies for the presence of hydrochloric acid. If it is present in the channel, then this indicates the gastric location of the fistula. But for the urinary fistula, the presence of uric acid salts is characteristic.

It should be especially noted that external fistulas are much easier to diagnose than internal ones. After all, they have a characteristic hole that can be seen by a specialist with the naked eye. With regard to internal fistulas, they should be detected not only by the existing symptoms and complaints of the patient, but also with the help of diagnostic methods such as ultrasound, radiography and endoscopy.

Fistula: treatment with official medicine

Therapy of patients with external fistulas is based on:

• local treatment;
• general therapeutic;
• operational.

By local therapy is meant the treatment of the formed wound, as well as the protection of the tissues surrounding it from the effects of the fluid that is released from the canal. For example, if the fistula is on the leg, abdomen, etc., then the purulent area is treated with various means (ointments, pastes and powders). They are applied at the outer opening of the canal, thereby preventing skin contact with pus, mucus, etc.

In addition, chemical agents can be used that exclude irritation of external tissues by neutralizing secretions from the fistulous passage. For this, it is recommended to use enzymes (for example, Gordoks, Kontrykal, etc.).

Mechanical methods of protecting the skin are primarily aimed at reducing or completely stopping the discharge from the canal with the help of special devices.

For the general treatment of purulent and other fistulas, they are constantly washed with an antiseptic solution.

Tubular granulating passages quite often close on their own after eliminating the causes of their occurrence (for example, removal of bone sequester, ligatures, etc.). But labial fistulas never go away on their own. For the treatment of such deviations, only surgical intervention is used to excise them, sew up external openings, or resect the affected organ.

It should also be noted that in some cases surgeons artificially form fistulas specifically so that the patient can eat, or in order to remove the accumulated secret from any internal organ. These channels can be either permanent or temporary. After the patient's condition improves, the temporary channels are closed surgically.

In addition to external, internal fistulas (interorganic) are also artificially created. As a rule, they are imposed either for a long time, or for life.

Treatment of a fistula with folk remedies

Of course, the treatment of such a deviation requires a mandatory consultation with an experienced doctor. Indeed, with untimely and incorrect therapy, a fistula can lead to serious complications that can endanger a person's life.

But, despite this likelihood, adherents of alternative medicine still use numerous folk methods to close the formed fistulas. Let's consider some of them in more detail.

Treatment of ligature fistula with aloe

To prepare the medicinal product, it is necessary to take 10-12 fleshy arrows from the presented plant, and then wash them in warm boiled water. Next, aloe needs to be finely chopped and placed in a liter jar. Pour 300 g of any honey into the container, cover loosely and put in a dark place for 7-10 days. In this case, after 4-5 days, it is desirable to mix the mass well. In conclusion, the tincture needs to be filtered several times and taken in a dessert spoon three times a day.

Ointment for external fistulas

Such an ointment serves well for the healing and treatment of vaginal fistulas, and for this we need water pepper grass, oak bark, lard and toad flowers. All imposed plants must be crushed, and then placed in a container and immediately poured with melted lard. In this case, the ratio of fat and herbs should be one to two.

After the done actions, it is necessary to put the filled dishes in the oven and turn on a slow fire. It is desirable to heat the ointment for at least 7-11 hours. In conclusion, the drug must be cooled at room temperature. The method of treatment with such an ointment is quite simple. To do this, you need to make a cotton swab, generously lubricate it with a remedy, and then attach it to the fistulous opening. It is advisable to change the bandages every five hours.

Decoctions from external fistulas

Infusions and decoctions of medicinal chamomile are used only externally - for washing holes. To prepare them, you need to take 1 large spoonful of dried flowers, brew them with one glass of boiling water, and then insist for 60 minutes and filter.

Also, decoctions made from calendula are used to wash fistulas and create compresses.

Prevention

Now you know how to treat a fistula, what it is, why it occurs. Prevention of acquired channels should include the prevention of infectious diseases. In addition, it is required to strictly observe the rules of asepsis during surgical interventions.

As for the prevention of congenital fistulas, this is impossible, since the disease occurs in the first trimester of pregnancy.

Hello Sergey.

Those "two holes" that have formed on your postoperative suture are nothing more than fistulas, which indicate the development of an inflammatory process in the human body after surgery. Fistulas can occur immediately after postoperative sutures are applied, and may appear many years after surgical interventions.

Infection and inflammation after surgery can occur for many reasons. If you are talking about the fact that pus is released from there, then the infection has definitely taken place.

By the way, the fistula channel can go not only outside, but also inside, therefore, pus goes out not only to the surface, but also to the internal cavity. Often this happens if during the operation a foreign body enters the body, which then begins to be rejected by the body, the patient behaved incorrectly after the operation, or the infection got into an open wound. Infection can have a strong impact on human immunity, and over time, the protective functions of the body gradually weaken, and the inflammatory process, accompanied by suppuration, intensifies.

Fistulas can be divided into certain types and depend on their location (rectal, gastric, bronchial, etc.). A ligature fistula is the one that appears after the imposition of non-absorbable threads. If you had stitches removed, then you had exactly ligature fistulas (since there are two holes). Ligature fistulas appear due to violations of the rules of antiseptic treatment of postoperative sutures and wounds after removal of surgical sutures.

The discharge of pus from the holes indicates that there is an infection in the wound. Also, when removing the threads, doctors could leave a part of the thread (ligature) in the wound, which infected the wound and led to suppuration. Also, the ligature could be infected initially, i. at the moment when the seam was just applied. The lack of treatment in this case leads not only to serious inflammatory processes, but also to complete or partial divergence of the seams.

Methods of treatment of postoperative fistulas

If a patient with a fistula has a strong enough body and strong immunity, then the therapy passes quickly, and the recovery period is not much delayed. If inflammation is observed at the site of the suture, then the treatment of ligature fistulas will most likely be carried out by surgical methods.

Diagnosis must be carried out for the presence of a foreign body in the wound. Today, modern technologies are used for this, giving a quick and truthful result. If the doctors' suspicions about the foreign object are confirmed, the fistulas will be opened, and both the foreign object and purulent masses will be removed through a special channel.

Further treatment may be medical, but this, as mentioned earlier, depends on the person's immunity, the specifics of infection and inflammation of the suture, as well as the vital activity of pathogenic microorganisms. Sometimes, after the manipulations, the fistula resolves itself, but this does not happen in all cases. In the absence of proper treatment, the disease will begin to actively progress, giving dangerous complications to the work of the whole organism.

• Methods of conservative therapy are used if there are few fistulas, and the amount of pus secreted does not exceed acceptable levels. Dead tissue is gradually removed and pus is removed, carrying out regular antiseptic measures to treat problem areas. In parallel, the patient takes antibacterial drugs and those whose action is aimed at strengthening the immune system.
• Surgical therapy is prescribed for patients who have a lot of fistulas, and the flow of purulent masses is plentiful and intense. If the presence of a foreign body or the development of complications is confirmed, then surgery is also indispensable. The operation is an excision of the fistulous canal, cauterization of the affected tissues or their removal. Sometimes the postoperative suture is removed along with fistulas - this is a complex and voluminous operation.

In any case, you need to urgently seek help from a surgeon who will take the necessary diagnostic measures and then prescribe an effective treatment.

Sincerely, Natalia.