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Fistula

May 03, 2023

This article is about the anatomical term. For the former legume subgenus, see Cassia (genus). For the metal straw used in Catholic liturgy, see Fistula (liturgical object).
Not to be confused with Vistula.

A fistula (plural: fistulas or fistulae /-li, -laɪ/; from Latin fistula, "tube, pipe") in anatomy is an abnormal connection between two hollow spaces (technically, two epithelialized surfaces), such as blood vessels, intestines, or other hollow organs.[2][3][4] Types of fistula can be described by their location. Anal fistulas connect between the anal canal and the perianal skin. Anovaginal or rectovaginal fistulas occur when a hole develops between the anus or rectum and the vagina. Colovaginal fistulas occur between the colon and the vagina. Urinary tract fistulas are abnormal openings within the urinary tract or an abnormal connection between the urinary tract and another organ such as between the bladder and the uterus in a vesicouterine fistula, between the bladder and the vagina in a vesicovaginal fistula, and between the urethra and the vagina in urethrovaginal fistula. When occurring between two parts of the intestine, it is known as an enteroenteral fistula, between the small intestine and the skin as an enterocutaneous fistula, and between the colon and the skin as a colocutaneous fistula.[3]

Fistula
Abdominal CT scan with right colocutaneous fistula and associated subcutaneous pneumatosis
Pronunciation
SpecialtyGeneral surgery

Fistulas can result from an infection or inflammation, injury or surgery.[5] Fistulas are sometimes surgically created as part of a treatment, for example arteriovenous fistulas for hemodialysis.[6]

Treatment for fistula varies depending on the cause and extent of the fistula, but often involves surgical intervention combined with antibiotic therapy. In some cases the fistula is temporarily covered using a fibrin glue or plug. Catheters may be required to drain a fistula.[3]

Globally, every year between 50,000 and 100,000 women are affected by fistula relating to childbirth.[7] In botany, the term is most common in its adjectival forms, where it is used in binomial names to refer to species that are distinguished by hollow or tubular structures. Monarda fistulosa, for example, has tubular flowers.[8] The term was first used in the 14th century.[2]

Definition

A fistula is an abnormal connection between vessels or organs that do not usually connect. It can be due to a disease or trauma, or purposely surgically created.[3][5]

Classification

Various types of fistulas include:

  • Blind: Only one open end; may also be called sinus tracts.[5]
  • Complete: Both internal and external openings.[5]
  • Incomplete: An external skin opening that does not connect to any internal organ.[5]

Although most fistulas are in forms of a tube, some can also have multiple branches.[citation needed]

Location

Types of fistula can be described by their location. Anal fistulas connect between the epithelialized surface of the anal canal and the perianal skin. Anovaginal or rectovaginal fistulas occur when a hole develops between the anus or rectum and the vagina. Colovaginal fistulas occur between the colon and the vagina. Urinary tract fistulas are abnormal openings within the urinary tract or an abnormal connection between the urinary tract and another organ such as between the bladder and the uterus in a vesicouterine fistula, between the bladder and the vagina in a vesicovaginal fistula, and between the urethra and the vagina in urethrovaginal fistula. When occurring between two parts of the intestine, it is known as an enteroenteral fistula, between the small intestine and the skin as an enterocutaneous fistula, and between the small intestine and the colon as a colocutaneous fistula.[3]

The following list is sorted by the International Statistical Classification of Diseases and Related Health Problems.

H: Diseases of the eye, adnexa, ear, and mastoid process

I: Diseases of the circulatory system

J: Diseases of the respiratory system

K: Diseases of the digestive system

 
Duodeno Biliary Fistula

M: Diseases of the musculoskeletal system and connective tissue

N: Diseases of the urogenital system

Q: Congenital malformations, deformations and chromosomal abnormalities

T: External causes

  • (T14.5) Traumatic arteriovenous fistula
  • (T81.8) Persistent postoperative fistula

Causes

 
Probed surgically excised gastrocutaneous fistula tract, that resulted from a previous gastrostomy tube.
  • Surgical and medical treatment: Complications from gallbladder surgery can lead to biliary fistulas.[12] As well as being congenital or resulting from trauma, arteriovenous fistulas are created purposefully for hemodialysis.[6] Radiation therapy to the pelvis can lead to vesicovaginal fistulas.[9] Persistent gastrocutaneous fistulas can develop after gastrostomy.[13]
  • Trauma: Prolonged childbirth can lead to fistulas in women, in whom abnormal connections may occur between the bladder and vagina, or the rectum and vagina.[9] An obstetric fistula develops when blood supply to the tissues of the vagina and the bladder (and/or rectum) is cut off during prolonged obstructed labor. The tissues die and a hole forms through which urine and/or feces pass uncontrollably. Vesicovaginal and rectovaginal fistulas may also be caused by rape, in particular gang rape, and rape with foreign objects, as evidenced by the abnormally high number of women in conflict areas who have developed fistulae.[14][15] In 2003, thousands of women in eastern Congo presented themselves for treatment of traumatic fistulas caused by systematic, violent gang rape, often also with sharp objects that occurred during the country's five years of war. So many cases have been reported that the destruction of the vagina is considered a war injury and recorded by doctors as a crime of combat.[16] Head trauma can lead to perilymph fistulas, whereas trauma to other parts of the body can cause arteriovenous fistulas.[17]

Treatment

Treatment for fistula varies depending on the cause and extent of the fistula, but often involves surgical intervention combined with antibiotic therapy. In some cases the fistula is temporarily covered, using a fibrin glue or plug. Catheters may be required to drain a fistula.[3]

Surgery is often required to assure adequate drainage of the fistula (so that pus may escape without forming an abscess). Various surgical procedures are used, most commonly fistulotomy, placement of a seton (a cord that is passed through the path of the fistula to keep it open for draining), or an endorectal flap procedure (where healthy tissue is pulled over the internal side of the fistula to keep feces or other material from reinfecting the channel).[18]

Management involves treating any underlying causative condition. For example, surgical treatment of fistulae in Crohn's disease can be effective, but if the Crohn's disease itself is not treated, the rate of recurrence of the fistula is very high (well above 50%).

Therapeutic use

In people with kidney failure, requiring dialysis, a cimino fistula is often deliberately created in the arm by means of a short day surgery in order to permit easier withdrawal of blood for hemodialysis.[citation needed]

As a radical treatment for portal hypertension, surgical creation of a portacaval fistula produces an anastomosis between the hepatic portal vein and the inferior vena cava across the omental foramen (of Winslow). This spares the portal venous system from high pressure which can cause esophageal varices, caput medusae, and hemorrhoids.[citation needed]

Epidemiology

Globally, every year between 50,000 and 100,000 women are affected by fistula relating to childbirth.[7]

Botany

In botany, the term is most common in its adjectival forms, where it is used in binomial names to refer to species that are distinguished by hollow or tubular structures. Monarda fistulosa, for example, has tubular flowers;[8] Eutrochium fistulosum has a tubular stem; Allium fistulosum has hollow or tubular leaves, and Acacia seyal subsp. fistula is the subspecies with hollow spines.[citation needed]

Society and culture

The term was first used in the 14th century.[2]

See also

References

  1. ^ Oxford English Dictionary. OED 2nd edition, 1989. (subscription required)
  2. ^ a b c d "Definition of Fistula". www.merriam-webster.com. Retrieved 28 December 2020.
  3. ^ a b c d e f "What Is A Fistula? Types, causes and treatments explained". Urinary incontinence education; National Association for Continence. Retrieved 28 December 2020.
  4. ^ Garefalakis, Maria; Hickey, Martha; Johnson, Neil (2016). "Gynecological Morbidity". In Quah, Stella R.; Cockerham, William C. (eds.). International Encyclopedia of Public Health (Second ed.). Elsevier. pp. 342–353. doi:10.1016/b978-0-12-803678-5.00178-8. ISBN 978-0-12-803678-5. A fistula is an abnormal connection or passageway between organs or vessels that are not normally connected.
  5. ^ a b c d e Rao, Jyotsna (2019). "Section II. General Surgery: Wounds, Sinuses, Fistulae". Qrs for Bds III Year-E Book (Third ed.). Elsevier Health Sciences. p. 256. ISBN 978-81-312-5535-3.
  6. ^ a b "Arteriovenous fistula - Symptoms and causes". Mayo Clinic. Retrieved 2019-12-05.
  7. ^ a b "Obstetric fistula". www.who.int.
  8. ^ a b Identification of Monarda fistulosa 2016-03-04 at the Wayback Machine subpage of Discover Life 2016-03-04 at the Wayback Machine , 2014.
  9. ^ a b c d "Fistulas: What are Fistulas? Fistulas Symptoms, Treatment, Diagnosis - UCLA". www.uclahealth.org. Retrieved 29 December 2020.
  10. ^ Carr, S; Velasco, AL (January 2020). "Fistula In Ano". StatPearls Publishing. PMID 32491449. {{cite journal}}: Cite journal requires |journal= (help)
  11. ^ Seksik, Philippe; Contou, Jean-Francois; Cosnes, Anne; Cosnes, Jacques (2006). "7. Hidradenitis Suppurativa and Crohn's Disease". In Jemec, Gregor B. E.; Revuz, Jean; Leyden, James J. (eds.). Hidradenitis Suppurativa. Springer. p. 53. ISBN 978-3-540-33100-1.
  12. ^ Crespi, M.; Montecamozzo, G.; Foschi, D. (2021-06-02). "Diagnosis and Treatment of Biliary Fistulas in the Laparoscopic Era". Gastroenterology Research and Practice. 2016: 1–6. doi:10.1155/2016/6293538. PMC 4706943. PMID 26819608.
  13. ^ Singhal, Shashideep MD2; Malieckal, Anju MD2; Culliford, Andrea MD1 Over the Scope Clip (OTSC) Closure of Persistently Leaking Gastrocutaneous Fistula after Failed Conventional Endoscopic Clipping Presidential Poster, American Journal of Gastroenterology: October 2012 - Volume 107 - Issue - p S532-S533
  14. ^ . Archived from the original on 2017-01-20. Retrieved 2007-12-11.
  15. ^ UNFPA: United Nations Population Fund. Press Release, 22 June 2006. "More Funding Needed to Help Victims of Sexual Violence"
  16. ^
  17. ^ Nagpal, Kamal; Ahmed, Kamran; Cuschieri, RJ (2021-06-02). "Diagnosis and management of acute traumatic arteriovenous fistula". The International Journal of Angiology. 17 (4): 214–216. doi:10.1055/s-0031-1278313. PMC 2728918. PMID 22477453.
  18. ^ Golub, R (1997). "Endorectal mucosal advancement flap: the preferred method for complex cryptoglandular fistula-in-ano". Journal of Gastrointestinal Surgery. Elsevier BV. 1 (5): 487–491. doi:10.1016/s1091-255x(97)80138-2. ISSN 1091-255X. PMID 17061335. S2CID 19188977.

External links

May 03, 2023
fistula, this, article, about, anatomical, term, former, legume, subgenus, cassia, genus, metal, straw, used, catholic, liturgy, liturgical, object, confused, with, vistula, fistula, plural, fistulas, fistulae, from, latin, fistula, tube, pipe, anatomy, abnorm. This article is about the anatomical term For the former legume subgenus see Cassia genus For the metal straw used in Catholic liturgy see Fistula liturgical object Not to be confused with Vistula A fistula plural fistulas or fistulae l i l aɪ from Latin fistula tube pipe in anatomy is an abnormal connection between two hollow spaces technically two epithelialized surfaces such as blood vessels intestines or other hollow organs 2 3 4 Types of fistula can be described by their location Anal fistulas connect between the anal canal and the perianal skin Anovaginal or rectovaginal fistulas occur when a hole develops between the anus or rectum and the vagina Colovaginal fistulas occur between the colon and the vagina Urinary tract fistulas are abnormal openings within the urinary tract or an abnormal connection between the urinary tract and another organ such as between the bladder and the uterus in a vesicouterine fistula between the bladder and the vagina in a vesicovaginal fistula and between the urethra and the vagina in urethrovaginal fistula When occurring between two parts of the intestine it is known as an enteroenteral fistula between the small intestine and the skin as an enterocutaneous fistula and between the colon and the skin as a colocutaneous fistula 3 FistulaAbdominal CT scan with right colocutaneous fistula and associated subcutaneous pneumatosisPronunciation ˈ f ɪ s tj ʊ l e 1 2 SpecialtyGeneral surgeryFistulas can result from an infection or inflammation injury or surgery 5 Fistulas are sometimes surgically created as part of a treatment for example arteriovenous fistulas for hemodialysis 6 Treatment for fistula varies depending on the cause and extent of the fistula but often involves surgical intervention combined with antibiotic therapy In some cases the fistula is temporarily covered using a fibrin glue or plug Catheters may be required to drain a fistula 3 Globally every year between 50 000 and 100 000 women are affected by fistula relating to childbirth 7 In botany the term is most common in its adjectival forms where it is used in binomial names to refer to species that are distinguished by hollow or tubular structures Monarda fistulosa for example has tubular flowers 8 The term was first used in the 14th century 2 Contents 1 Definition 2 Classification 2 1 Location 2 2 H Diseases of the eye adnexa ear and mastoid process 2 3 I Diseases of the circulatory system 2 4 J Diseases of the respiratory system 2 5 K Diseases of the digestive system 2 6 M Diseases of the musculoskeletal system and connective tissue 2 7 N Diseases of the urogenital system 2 8 Q Congenital malformations deformations and chromosomal abnormalities 2 9 T External causes 3 Causes 4 Treatment 5 Therapeutic use 6 Epidemiology 7 Botany 8 Society and culture 9 See also 10 References 11 External linksDefinition EditA fistula is an abnormal connection between vessels or organs that do not usually connect It can be due to a disease or trauma or purposely surgically created 3 5 Classification EditVarious types of fistulas include Blind Only one open end may also be called sinus tracts 5 Complete Both internal and external openings 5 Incomplete An external skin opening that does not connect to any internal organ 5 Although most fistulas are in forms of a tube some can also have multiple branches citation needed Location Edit Types of fistula can be described by their location Anal fistulas connect between the epithelialized surface of the anal canal and the perianal skin Anovaginal or rectovaginal fistulas occur when a hole develops between the anus or rectum and the vagina Colovaginal fistulas occur between the colon and the vagina Urinary tract fistulas are abnormal openings within the urinary tract or an abnormal connection between the urinary tract and another organ such as between the bladder and the uterus in a vesicouterine fistula between the bladder and the vagina in a vesicovaginal fistula and between the urethra and the vagina in urethrovaginal fistula When occurring between two parts of the intestine it is known as an enteroenteral fistula between the small intestine and the skin as an enterocutaneous fistula and between the small intestine and the colon as a colocutaneous fistula 3 The following list is sorted by the International Statistical Classification of Diseases and Related Health Problems H Diseases of the eye adnexa ear and mastoid process Edit H04 6 Lacrimal fistula H05 81 Carotid cavernous fistula H70 1 Mastoid fistula Craniosinus fistula between the intracranial space and a paranasal sinus H83 1 Labyrinthine fistula Perilymph fistula tear between the membranes between the middle and inner ears Preauricular fistula Preauricular fistula usually on the top of the cristae helicis of the earsI Diseases of the circulatory system Edit I25 4 Coronary arteriovenous fistula acquired I28 0 Arteriovenous fistula of pulmonary vessels Pulmonary arteriovenous fistula between an artery and vein of the lungs resulting in shunting of blood This results in improperly oxygenated blood I67 1 Cerebral arteriovenous fistula acquired I77 0 Arteriovenous fistula acquired I77 2 Fistula of arteryJ Diseases of the respiratory system Edit J86 0 Pyothorax with fistula J95 0 Tracheoesophageal fistula between the trachea and the esophagus This may be congenital or acquired for example as a complication of a tracheostomy K Diseases of the digestive system Edit Duodeno Biliary Fistula K11 4 Salivary gland fistula K31 6 Fistula of stomach and duodenum K31 6 Gastrocolic fistula K31 6 Gastrojejunocolic fistula after a Billroth II a fistula forms between the transverse colon and the upper jejunum which post Billroth II is attached to the remainder of the stomach Fecal matter passes improperly from the colon to the stomach and causes halitosis Enterocutaneous fistula between the intestine and the skin surface namely from the duodenum or the jejunum or the ileum This definition excludes the fistulas arising from the colon or the appendix Gastric fistula from the stomach to the skin surface K38 3 Fistula of appendix K60 Anal and rectal fissures and fistulas K60 3 Anal fistula K60 5 Anorectal fistula fecal fistula fistula in ano connecting the rectum or other anorectal area to the skin surface This results in abnormal discharge of feces through an opening other than the anus K63 2 Fistula of intestine Enteroenteral fistula between two parts of the intestine K82 3 Fistula of gallbladder K83 3 Fistula of bile duct Biliary fistula connecting the bile ducts to the skin surface often caused by gallbladder surgery Pancreatic fistula between the pancreas and the exterior via the abdominal wallM Diseases of the musculoskeletal system and connective tissue Edit M25 1 Fistula of jointN Diseases of the urogenital system Edit N32 1 Vesicointestinal fistula N36 0 Urethral fistula Innora between the prostatic utricle and the outside of the body N64 0 Fistula of nipple N82 Fistulae involving female genital tract Obstetric fistula N82 0 Vesicovaginal fistula between the bladder and the vagina N82 1 Other female urinary genital tract fistulae Cervical fistula abnormal opening in the cervix N82 2 Fistula of vagina to small intestine Enterovaginal fistula between the intestine and the vagina N82 3 Fistula of vagina to large intestine Rectovaginal between the rectum and the vagina N82 4 Other female intestinal genital tract fistulae N82 5 Female genital tract skin fistulae N82 8 Other female genital tract fistulae N82 9 Female genital tract fistula unspecifiedQ Congenital malformations deformations and chromosomal abnormalities Edit Q18 0 Sinus fistula and cyst of branchial cleft Congenital preauricular fistula A small pit in front of the ear Also known as an ear pit or preauricular sinus Q26 6 Portal vein hepatic artery fistula Q38 0 Congenital fistula of lip Q38 4 Congenital fistula of salivary gland Q42 0 Congenital absence atresia and stenosis of rectum with fistula Q42 2 Congenital absence atresia and stenosis of anus with fistula Q43 6 Congenital fistula of rectum and anus Q51 7 Congenital fistulae between uterus and digestive and urinary tracts Q52 2 Congenital rectovaginal fistulaT External causes Edit T14 5 Traumatic arteriovenous fistula T81 8 Persistent postoperative fistulaCauses EditDisease Infections including an anorectal abscess and inflammatory diseases including Crohn s disease and ulcerative colitis can result in fistulas 9 10 Fistulas to the anus may occur in hidradenitis suppurativa 11 In women fistulas can also occur following pelvic infection and inflammation 9 Probed surgically excised gastrocutaneous fistula tract that resulted from a previous gastrostomy tube Surgical and medical treatment Complications from gallbladder surgery can lead to biliary fistulas 12 As well as being congenital or resulting from trauma arteriovenous fistulas are created purposefully for hemodialysis 6 Radiation therapy to the pelvis can lead to vesicovaginal fistulas 9 Persistent gastrocutaneous fistulas can develop after gastrostomy 13 Trauma Prolonged childbirth can lead to fistulas in women in whom abnormal connections may occur between the bladder and vagina or the rectum and vagina 9 An obstetric fistula develops when blood supply to the tissues of the vagina and the bladder and or rectum is cut off during prolonged obstructed labor The tissues die and a hole forms through which urine and or feces pass uncontrollably Vesicovaginal and rectovaginal fistulas may also be caused by rape in particular gang rape and rape with foreign objects as evidenced by the abnormally high number of women in conflict areas who have developed fistulae 14 15 In 2003 thousands of women in eastern Congo presented themselves for treatment of traumatic fistulas caused by systematic violent gang rape often also with sharp objects that occurred during the country s five years of war So many cases have been reported that the destruction of the vagina is considered a war injury and recorded by doctors as a crime of combat 16 Head trauma can lead to perilymph fistulas whereas trauma to other parts of the body can cause arteriovenous fistulas 17 Treatment EditTreatment for fistula varies depending on the cause and extent of the fistula but often involves surgical intervention combined with antibiotic therapy In some cases the fistula is temporarily covered using a fibrin glue or plug Catheters may be required to drain a fistula 3 Surgery is often required to assure adequate drainage of the fistula so that pus may escape without forming an abscess Various surgical procedures are used most commonly fistulotomy placement of a seton a cord that is passed through the path of the fistula to keep it open for draining or an endorectal flap procedure where healthy tissue is pulled over the internal side of the fistula to keep feces or other material from reinfecting the channel 18 Management involves treating any underlying causative condition For example surgical treatment of fistulae in Crohn s disease can be effective but if the Crohn s disease itself is not treated the rate of recurrence of the fistula is very high well above 50 Therapeutic use EditIn people with kidney failure requiring dialysis a cimino fistula is often deliberately created in the arm by means of a short day surgery in order to permit easier withdrawal of blood for hemodialysis citation needed As a radical treatment for portal hypertension surgical creation of a portacaval fistula produces an anastomosis between the hepatic portal vein and the inferior vena cava across the omental foramen of Winslow This spares the portal venous system from high pressure which can cause esophageal varices caput medusae and hemorrhoids citation needed Epidemiology EditGlobally every year between 50 000 and 100 000 women are affected by fistula relating to childbirth 7 Botany EditIn botany the term is most common in its adjectival forms where it is used in binomial names to refer to species that are distinguished by hollow or tubular structures Monarda fistulosa for example has tubular flowers 8 Eutrochium fistulosum has a tubular stem Allium fistulosum has hollow or tubular leaves and Acacia seyal subsp fistula is the subspecies with hollow spines citation needed Society and culture EditThe term was first used in the 14th century 2 See also EditAlexis St Martin Fistulated cow Obstetric fistula Stoma medicine References Edit Oxford English Dictionary OED 2nd edition 1989 subscription required a b c d Definition of Fistula www merriam webster com Retrieved 28 December 2020 a b c d e f What Is A Fistula Types causes and treatments explained Urinary incontinence education National Association for Continence Retrieved 28 December 2020 Garefalakis Maria Hickey Martha Johnson Neil 2016 Gynecological Morbidity In Quah Stella R Cockerham William C eds International Encyclopedia of Public Health Second ed Elsevier pp 342 353 doi 10 1016 b978 0 12 803678 5 00178 8 ISBN 978 0 12 803678 5 A fistula is an abnormal connection or passageway between organs or vessels that are not normally connected a b c d e Rao Jyotsna 2019 Section II General Surgery Wounds Sinuses Fistulae Qrs for Bds III Year E Book Third ed Elsevier Health Sciences p 256 ISBN 978 81 312 5535 3 a b Arteriovenous fistula Symptoms and causes Mayo Clinic Retrieved 2019 12 05 a b Obstetric fistula www who int a b Identification of Monarda fistulosa Archived 2016 03 04 at the Wayback Machine subpage of Discover Life Archived 2016 03 04 at the Wayback Machine 2014 a b c d Fistulas What are Fistulas Fistulas Symptoms Treatment Diagnosis UCLA www uclahealth org Retrieved 29 December 2020 Carr S Velasco AL January 2020 Fistula In Ano StatPearls Publishing PMID 32491449 a href Template Cite journal html title Template Cite journal cite journal a Cite journal requires journal help Seksik Philippe Contou Jean Francois Cosnes Anne Cosnes Jacques 2006 7 Hidradenitis Suppurativa and Crohn s Disease In Jemec Gregor B E Revuz Jean Leyden James J eds Hidradenitis Suppurativa Springer p 53 ISBN 978 3 540 33100 1 Crespi M Montecamozzo G Foschi D 2021 06 02 Diagnosis and Treatment of Biliary Fistulas in the Laparoscopic Era Gastroenterology Research and Practice 2016 1 6 doi 10 1155 2016 6293538 PMC 4706943 PMID 26819608 Singhal Shashideep MD2 Malieckal Anju MD2 Culliford Andrea MD1 Over the Scope Clip OTSC Closure of Persistently Leaking Gastrocutaneous Fistula after Failed Conventional Endoscopic Clipping Presidential Poster American Journal of Gastroenterology October 2012 Volume 107 Issue p S532 S533 Stephanie Nolen Not Women Anymore Ms Magazine Spring 2005 Archived from the original on 2017 01 20 Retrieved 2007 12 11 UNFPA United Nations Population Fund Press Release 22 June 2006 More Funding Needed to Help Victims of Sexual Violence Emily Wax Washington Post Foreign Service Saturday October 25 2003 Page A01 A Brutal Legacy of Congo War Nagpal Kamal Ahmed Kamran Cuschieri RJ 2021 06 02 Diagnosis and management of acute traumatic arteriovenous fistula The International Journal of Angiology 17 4 214 216 doi 10 1055 s 0031 1278313 PMC 2728918 PMID 22477453 Golub R 1997 Endorectal mucosal advancement flap the preferred method for complex cryptoglandular fistula in ano Journal of Gastrointestinal Surgery Elsevier BV 1 5 487 491 doi 10 1016 s1091 255x 97 80138 2 ISSN 1091 255X PMID 17061335 S2CID 19188977 External links Edit Retrieved from https en wikipedia org w index php title Fistula amp oldid 1144870228, wikipedia, wiki, book, books, library,

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