Moche intestinal fistula - Causes, Symptoms and Treatment .MF .
Mochekishechnye fistula - a pathological connection between the organs of the urinary tract (ureter, bladder), and gastrointestinal tract (thin, thick or rectum).
reasons mochekishechnyh fistula
All mochekishechnye fistulas are divided into two groups: congenital and acquired.Congenital fistulae mochekishechnye observed only in patients with uretrorektalnymi and vesico-rectal fistulas, which are often combined with imperforate anus and rectum in newborns.According to international classification, this disease has been called "a form of anal fistula and anorectal agenesis."It refers to one of the malformations in males and is found in 50-90% of infants with a higher form of rectal atresia.
Among acquired mochekishechnyh isolated traumatic fistula and spontaneous.
Injury (household, industrial, transport, operational) may be the cause of the formation of a fistula at any level, but especially often observed uretrorektalnye traumatic fistula.The term "spontaneous" fist
very small group are patients with an artificial mochekishechnymi fistulas, which are formed for the purpose of diversion from the bladder into the rectum after unsuccessful plastic surgery to restore patency of the urethra.
Spontaneous renal intestinal fistulas are more common traumatic.The most frequent form of renal colonic fistulae.The main reason of their education are kidney disease - calculous pyonephrosis or tuberculosis, kidney abscess and suppuration of simple renal cysts.
Symptoms mochekishechnyh fistula
Clinical manifestations of abnormal connection between organs of the urinary system and intestine depends on many things, among which, first of all, you must specify the localization of sinus openings, the length and diameter of the fistulous tract, renal function, the existence of obstacles to the flow of urinealong the lower urinary tract fistula and numerous suppurative complications.
clinical picture of the underlying disease in spontaneous fistulas, and the effects of trauma in traumatic fistula may prevail over the symptoms mochekishechnogo fistula or serve as a background against which the fore the characteristics of pathological communication.
Despite the variety of clinical signs, symptoms of functional disorders of the urinary system are most typical for mochekishechnyh fistulas and in a significant number of cases based on complaints allow patients to suspect their presence.These characteristics should be attributed primarily air release in the urine, which often occurs with vesico-intestinal fistula, rarely on this symptom patients complain with pochechno- and ureterovaginal intestinal fistulas
Much less air release revealed with the release of feces.At high relative to the intestine fistula observed in the urine and bile of food, at the location of the fistula opening in the colon and small intestine - a liquid or a formed stool.
Receipt of urine into the intestine - a frequent symptom in patients with puzyrno- uretrorektalnymi and fistulas.
Intestinal symptoms often diarrhea, sometimes constipation, and sometimes both.Patients detected blood in the stool.
Other symptoms observed flatulence, pain in the course of the colon or small intestine and the various manifestations of partial intestinal obstruction
If there is a patient of similar symptoms, especially after suffering a previous inflammatory diseases of the genitourinary system, it is necessary to address for consultation to the urologist to rule out the diagnosismochekishechnogo fistula.
Diagnostics mochekishechnyh fistula
addition to a thorough medical history, inspection and palpation, which is best done under general anesthesia, be sure to use a range of endoscopic techniques, including cystoscopy, colonoscopy and, if indicated, laparoscopy.
The diagnosis of fistulas mochekishechnyh widely used radiological methods.Excretory urography, made with a double dose of X-ray contrast agents or infusion procedure is mandatory in all cases.Calibration is done after receiving the survey radiographs of the urinary tract, which can detect the shadow of stones or gas in the projection of the urinary system.Excretory urography provides information on the status and function of the kidneys, ureters and bladder, as well as to ascertain the penetration of contrast agent into the intestine and thus determine the localization of the intestinal opening.Identify fistula on excretory urography, as a rule, it is possible only with a relatively large opening in the urinary organs, with the direct and shorter course of fistula.
more informative data gives cystography, which is recommended to be performed in two projections before and after urination to determine not only the fistula, and vesicoureteral reflux.X-ray study of intestinal necessarily, but the detection of fistula, this method is much inferior contrast radiography of the bladder, so it allows diagnosing fistula in no more than 20% of cases.
with open fistulas uretrorektalnyh spend urethrography introduced through the urethra into the metal or rubber catheter, which allows tight fill fistula contrast agent and get an idea of the localization of the fistula opening in the urethra, and intestine.
Application of endoscopy in conjunction with the introduction of colored liquid in some cases reveals fistulous openings, but Dayan method is only complementary to X-ray.
Treatment mochekishechnyh fistula
The only effective treatment for the disease is surgery.The amount and type of operation are determined by the size of the fistula and its location, as well as the bodies in which it is located.
When small amounts of fistula hole, the operation may be limited carved granulation tissue and wound closure on the organ.A more impressive size of the pathological openings own tissues may be insufficient for effective plastics.In such cases, it may be carried artificial plastic material or other tissues.For example, quite often for closing the hole in the bladder can be used small or large intestine, which is applied to the wound of the bladder and fixed several serous sutures.Well suited for this purpose and the flap of the greater omentum, which, apart from the serous membrane, has expressed the blood vessel system.The latter can germinate in the anastomosis site, providing a good blood supply, which is good for wound healing.
operation on excision of a fistula
If absolute contraindications for surgery patients may be offered and the conservative tactics of the disease.For this fistulous cavity is washed daily with antiseptic solutions and to introduce anti-bacterial ointment composition.In the absence of a secondary infection and the small size of the fistula, after some time we can hope for spontaneous closure of the course.
disease Postoperative patients should be sure to wear some time urethral catheter as increased pressure in the bladder may adversely affect the wound healing of its walls.Patients need to learn how to properly use urethral catheter, change it regularly and to enter into the cavity of the bladder antiseptic solutions such as chlorhexidine, which prevent the development of secondary infection.
Feeding habits and lifestyle
special diet for the treatment of fistulas mochekishechnyh not yet developed.Unless patients are contraindicated surgery and in whom there is a selection of feces in the urine, it is recommended to eat more roughage, so that liquid stool does not fall into the fistula.
Treatment folk remedies
As a rule, non-native healers do not go deep into the cause of the disease and treat only the most severe symptoms.Due to the wrong point of applying the treatment, their therapy is often ineffective.A variety of herbal teas, which they offer to wash the external genitals, vagina and rectum, have only a temporary antiseptic effect, but does not cure the pathology.
Complications mochekishechnyh fistula
Contact with fecal content into the lumen of the bladder can have the most to perceive itself as a complication.Infection of the bladder, which is celebrated in this situation, it becomes a cause of complaints of persistent pain and cramps during urination, as well as general weakness, malaise, and fever.
When infected bladder infection can climb higher, affecting the kidneys.At the same time there is soreness, but not above the pubis, and in the lumbar region.Such patients becomes difficult to urinate because of any urge to urinate accompanied by discomfort and pain.This clinical situation can become a cause of renal dysfunction and acute renal failure.In the absence of adequate treatment at this stage, the disease is inevitably fatal.
Prevention mochekishechnyh fistula
To prevent the disease, it is necessary, first of all, affect the causal factors.Since mochekishechnye fistula is almost always associated with a bacterial infection, patients with such problems it is necessary to actively engage in their treatment.Non-durable course of antibiotic therapy can completely remove the questions about the risk of developing pathology.
Weather Forecast for life - favorable.Although described deaths, they are rare and are caused, as a rule, lack of medical care.
prognosis for recovery - relatively favorable.You can not cure the disease only in those patients who are completely contraindicated surgery because of severe diseases of internal organs.
forecast for performance - relatively favorable.For the first time after the operation the patient is necessary to limit itself in heavy physical activity, which could not only cause deterioration of general condition, but a fistula recurrence mochekishechnogo.
Ed.urologist, sexologist-andrologist Plotnikov AN