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Intestinal Fistulas Clinical Presentation

  • Author: David E Stein, MD; Chief Editor: Julian Katz, MD  more...
Updated: Dec 16, 2014

History and Physical Examination


Symptoms caused by fistulas that involve 2 segments of the bowel vary depending on the location of the fistula and the amount of bowel bypassed. For this reason, enteroenteric fistulas in which only a short segment of bowel is bypassed may be asymptomatic and diagnosed incidentally based on imaging findings or during surgery. Conversely, ileosigmoid fistula may cause diarrhea, weight loss, or abdominal pain.[8]

Patients with gastrocolic fistulas may present with symptoms of abdominal pain, weight loss, and feculent belching.

Enterovesical and colovesical fistulas are easier to diagnose in patients who present with symptoms of pneumaturia, fecaluria, and recurrent urinary tract infections.[9]

Patients with rectovaginal and anovaginal fistulas may be asymptomatic and present with symptoms only when the bowel movements are more liquid. Possible symptoms include inadvertent passage of stool or gas, dyspareunia, and perineal pain.

Patients with external fistulas generally present with symptoms of drainage through the skin. Patients with aortoenteric fistulas may report rectal bleeding.

Physical examination

Fluid or stool output through the skin, diarrhea, abdominal tenderness, weight loss, signs of malnutrition, and electrolyte imbalances are all possible findings in patients with fistulas.

Rectal bleeding may be a finding in patients with a history of radiation therapy. Hypotension and rectal bleeding may occur in patients with aortoenteric fistulas.

Contributor Information and Disclosures

David E Stein, MD Chief, Division of Colorectal Surgery, Associate Professor, Department of Surgery, Director, Mini-Medical School Program, Drexel University College of Medicine; Chief, Division of Colorectal Surgery, Department of Surgery, Hahneman University Hospital; Consultant, Merck; Consultant, Ethicon Endo-Surgery; Consultant, Health Partners; Consultant, Cook Surgical

David E Stein, MD is a member of the following medical societies: American College of Surgeons, American Society of Colon and Rectal Surgeons, Association for Surgical Education, Pennsylvania Medical Society, Society for Surgery of the Alimentary Tract, Crohn's and Colitis Foundation of America

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Merck<br/>Serve(d) as a speaker or a member of a speakers bureau for: Merck.


Asyia S Ahmad, MD Assistant Professor of Medicine, Division of Gastroenterology and Hepatology, Associate Program Director, Gastroenterology and Hepatology Fellowship Training Program, Drexel University College of Medicine

Asyia S Ahmad, MD is a member of the following medical societies: American Gastroenterological Association, American Neurogastroenterology and Motility Society, American Society for Gastrointestinal Endoscopy, Pennsylvania Medical Society

Disclosure: Nothing to disclose.

Radha V Menon, MD Resident Physician, Department of Internal Medicine, Drexel University College of Medicine

Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD Clinical Professor of Medicine, Drexel University College of Medicine

Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law, Medicine & Ethics, American Trauma Society, Association of American Medical Colleges, Physicians for Social Responsibility

Disclosure: Nothing to disclose.


Christopher K Chiu, MD Staff Physician, Department of General Surgery, Drexel University College of Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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Enterocutaneous fistula after bowel injury from an incisional hernia repair, 6 weeks postinjury.
Status post-pancreatic debridement for necrotizing pancreatitis. The patient had a colonic injury with attempted closure using a skin graft. The patient later underwent definitive repair.
Psoas abscess from Crohn disease that later fistulized to the skin.
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