Intestinal Fistulas Clinical Presentation

Updated: Mar 08, 2018
  • Author: David E Stein, MD, MHCM; Chief Editor: Burt Cagir, MD, FACS  more...
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History and Physical Examination


Symptoms caused by fistulas that involve two 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. [11]

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. [12]

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. In patients with an anorectal abscess and/or anal fistula, the American Society of Colon and Rectal Surgeons indicates obtaining a thorough disease-specific history with an emphasis on symptoms, risk factors, site, presence of secondary cellulitis, and anal fistula. [13]

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.