Download PDF
CC BY-NC-ND 4.0 · Journal of Gastrointestinal and Abdominal Radiology 2023; 06(01): 015-020
DOI: 10.1055/s-0042-1758124
Original Article

Role of Multidetector Computed Tomography in Diagnosis of Acquired Gastrointestinal Fistulas

Gitanjali Arora 
1   Department of Radio-Diagnosis, King Edward Memorial Hospital, Mumbai, Maharashtra, India
,
Padma V. Badhe
1   Department of Radio-Diagnosis, King Edward Memorial Hospital, Mumbai, Maharashtra, India
› Author Affiliations
› Further Information
   Permissions and Reprints

Abstract

Introduction Fistulas are abnormal communication between two epithelialized surfaces. Gastrointestinal fistulas are communication between the gut and another epithelialized surface. Fistulas are classified according to anatomic (internal or external), physiologic (output volume), and etiologic characteristics. In the case of clinical suspicion of a fistula, a multidisciplinary approach helps in diagnosing and management. Multidetector computed tomography (MDCT) has an advantage over other imaging modalities due to its ability to reconstruct high-resolution images in seconds, which limits motion or peristalsis artifacts, and is ideal for patients who are uncooperative or who are seriously ill.

Aim Evaluation of MDCT as an initial tool in the diagnosis and characterization of gastrointestinal fistulas.

Methods During this prospective observational study, MDCT was used to assess patients with clinical suspicion of gastrointestinal fistulas. When necessary, contrast agents were used to identify the enteric fistulous tract. The etiology and characterization of the fistulas were determined. Further, the gastrointestinal fistulas were confirmed via endoscopy, cystoscopy, or surgery.

Results The most common type of gastrointestinal fistula is enterocutaneous fistula (ECF) (39%) and the most common cause of gastrointestinal fistulas is postoperative (47%). ECFs were classified according to their etiology, anatomy, and favorable characteristics (85% favorable) along with complexity (64% complex) to aid in the management process. In addition to pancreaticopleural fistulas (22%), biliary (11%), esophageal (8%), and pelvic fistulas (19%) were also observed. There were 19% of fistulas (esophageal and biliary) that were asymptomatic. Endoscopy confirmed such asymptomatic fistulas that were not convincingly detected on CT.

Conclusion In this study, we concluded that with the appropriate clinical history, MDCT can accurately depict enteric fistulas. In addition to characterizing fistulas, MDCT is equally useful for detecting secondary complications like inflammation, obstruction, or abscesses.

Keywords

gastrointestinal fistulas - multidetector computed tomography - enterocutaneous fistulas - pelvic fistulas - pancreaticopleural fistulas


Publication History

Article published online:
30 December 2022

© 2022. Indian Society of Gastrointestinal and Abdominal Radiology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Berry SM, Fischer JE. Classification and pathophysiology of enterocutaneous fistulas. Surg Clin North Am 1996; 76 (05) 1009-1018
    CrossrefPubMedGoogle Scholar
  • 2 Cowan KB, Cassaro S. Enterocutaneous Fistula. August 11, 2021. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing; 2022
    Google Scholar
  • 3 Tonolini M, Magistrelli P. Enterocutaneous fistulas: a primer for radiologists with emphasis on CT and MRI. Insights Imaging 2017; 8 (06) 537-548
    CrossrefPubMedGoogle Scholar
  • 4 Orangio GR. Enterocutaneous fistula: medical and surgical management including patients with Crohn's disease. Clin Colon Rectal Surg 2010; 23 (03) 169-175
    Article in Thieme ConnectPubMedGoogle Scholar
  • 5 Winklhofer S, Lambert JW, Wang ZJ. et al. Reduction of peristalsis-related gastrointestinal streak artifacts with dual-energy CT: a patient and phantom study. Abdom Radiol (NY) 2016; 41 (08) 1456-1465
    CrossrefPubMedGoogle Scholar
  • 6 Stawicki Stanislaw P, Braslow Benjamin M. Gastrointestinal fistulae. IJAM 2017; 3: 77-81
    Google Scholar
  • 7 Farooqi N, Tuma F. Intestinal Fistulas. Colorectal Surgery (Fifth Edition). W.B. Saunders; 2014: 289-304
    Google Scholar
  • 8 Little BP, Mendoza DP, Fox A. et al. Direct and indirect CT imaging features of esophago-airway fistula in adults. J Thorac Dis 2020; 12 (06) 3157-3166
    CrossrefPubMedGoogle Scholar
  • 9 Angrisani L, Corcione F, Tartaglia A. et al. Cholecystoenteric fistula (CF) is not a contraindication for laparoscopic surgery. Surg Endosc 2001; 15 (09) 1038-1041
    CrossrefPubMedGoogle Scholar
  • 10 Ha GW, Lee MR, Kim JH. Cholecystocolic fistula caused by gallbladder carcinoma: preoperatively misdiagnosed as hepatic colon carcinoma. World J Gastroenterol 2015; 21 (15) 4765-4769
    CrossrefPubMedGoogle Scholar
  • 11 King JC, Reber HA, Shiraga S, Hines OJ. Pancreatic-pleural fistula is best managed by early operative intervention. Surgery 2010; 147 (01) 154-159
    CrossrefPubMedGoogle Scholar
  • 12 Wypych K, Serafin Z, Gałązka P. et al. Pancreaticopleural fistulas of different origin: report of two cases and a review of literature. Pol J Radiol 2011; 76 (02) 56-60
    PubMedGoogle Scholar
  • 13 Cocieru A, Saldinger PF. Frey procedure for pancreaticopleural fistula. J Gastrointest Surg 2010; 14 (05) 929-930
    CrossrefPubMedGoogle Scholar
  • 14 Falconi M, Pederzoli P. The relevance of gastrointestinal fistulae in clinical practice: a review. Gut 2001; 49 (Suppl. 04) iv2-iv10
    PubMedGoogle Scholar
  • 15 Weledji EP. Perspectives on enterocutaneous fistula: a review article. Med Clin Rev 2017; 3: 5
    CrossrefGoogle Scholar
  • 16 Rubelowsky J, Machiedo GW. Reoperative versus conservative management for gastrointestinal fistulas. Surg Clin North Am 1991; 71 (01) 147-157
    CrossrefPubMedGoogle Scholar
  • 17 Schein M, Decker GA. Postoperative external alimentary tract fistulas. Am J Surg 1991; 161 (04) 435-438
    CrossrefPubMedGoogle Scholar
  • 18 Gribovskaja-Rupp I, Melton GB. Enterocutaneous fistula: proven strategies and updates. Clin Colon Rectal Surg 2016; 29 (02) 130-137
    Article in Thieme ConnectPubMedGoogle Scholar
  • 19 Moon SG, Kim SH, Lee HJ, Moon MH, Myung JS. Pelvic fistulas complicating pelvic surgery or diseases: spectrum of imaging findings. Korean J Radiol 2001; 2 (02) 97-104
    CrossrefPubMedGoogle Scholar
  • 20 Golabek T, Szymanska A, Szopinski T. et al. Enterovesical fistulae: aetiology, imaging, and management. Gastroenterol Res Pract 2013; 2013: 617967
    CrossrefPubMedGoogle Scholar
  • 21 Berger MB, Khandwala N, Fenner DE, Burney RE. Colovaginal fistulas: presentation, evaluation, and management. Female Pelvic Med Reconstr Surg 2016; 22 (05) 355-358
    CrossrefPubMedGoogle Scholar
  • 22 Debeche-Adams TH, Bohl JL. Rectovaginal fistulas. Clin Colon Rectal Surg 2010; 23 (02) 99-103
    Article in Thieme ConnectPubMedGoogle Scholar