Contents
Fistuloscopy is a method for diagnosing fistulas formed in the intestines. Fistulas or fistulas are pathological formations between the intestinal lumen and another organ or external environment. This is a serious surgical disease that requires detailed study and precise therapy. The examination makes it possible to identify the disease in the early stages, determine the direction and size of the fistula, and find treatment tactics.
What does fistuloscopy give?
Fistuloscopy is done for a detailed study and treatment of intestinal fistulas. To select the correct tactics of therapy, it is necessary to accurately determine the location, extent, type of fistula. An intestinal fistula is an unnatural passage between the intestine and the external environment or another internal organ. Distinguish between internal and external formations. The internal communicates the intestinal cavity with another organ, it can be asymptomatic for a long time and does not go outside. External connects the intestines with the skin, while forming an external outlet to the external environment. Through the external opening of the fistula, gases, feces, and mucus are released.
Both internal and external fistula are considered very dangerous diseases. They lead to intoxication of the body, infection, loss of weight and nutrients, and serious mental problems. An internal fistula can connect the intestines to the urinary or gallbladder, urethra, uterus, or vagina.
All biological masses passing through the intestines enter the cavities of these organs. There are also mixed types of fistulas that communicate with both the external environment and internal organs.
The reason for this phenomenon may be congenital pathology in infants. As a rule, such deviations are noticed even during the gestation period during ultrasound, however, treatment can be prescribed only after childbirth. Most cases of intestinal fistulas fall on acquired forms. This is due to inflammatory processes in the small or large intestine, among them: tumors, acute appendicitis, Crohn’s disease, tuberculosis of the intestinal tube. Blunt and penetrating abdominal trauma, gunshot wounds also lead to the formation of such passages.
Incorrect operations on the abdominal organs or intestines also lead to such complications. A fistula is formed when the sutures of the internal organs are incorrectly applied, when a foreign body (ligature, napkin, tampon) is left. The most dangerous location is considered to be the upper external fistula – a formation in the upper intestine. With such a history, the patient loses a large amount of fluid and useful minerals, which leads to more serious complications: renal and liver failure, multiple organ failure, etc.
Fistulas are diagnosed using an abdominal x-ray with contrast, abdominal ultrasound, barium enema, multislice computed tomography.
However, fistuloscopy provides the most information. It is carried out using an endoscope – a thin tube with a diameter of 3-4 mm with a point of illumination and an optical device. The doctor during the procedure introduces this device into the course of the fistula and examines it in detail. This allows you to accurately determine the state of the epithelium inside the formation, to establish its size and shape.
With an external fistula, the endoscope is inserted through the external mouth, with internal formations, the device is inserted into the large intestine through the anus and led to the fistula. Manipulations are possible only if the diameter of the fistula exceeds 3 mm.
In what cases is it prescribed
Fistuloscopy is performed when the patient has formed external or internal fistulas of the gastrointestinal tract. It is prescribed only in case of a confirmed diagnosis, if there are no other methods for accurate diagnosis.
The indications for the procedure are internal fistulas located no further than 25 cm from the anus, external and internal fistulas, the diameter of which exceeds 3 mm, external bile ducts. Such a study is necessary when the x-ray picture is unclear or x-rays cannot be taken. Sometimes the doctor needs to clarify the characteristics of the tissues in the fistula to determine the correct treatment, in which case they are sent for an endoscopic examination and a biopsy is performed. When the morphology of the disease is known, the patient needs therapy, in such a situation only fistuloscopy will also help.
Preparing for the procedure
First of all, the patient is examined by a proctologist or surgeon. Before endoscopic examination, fistulas are studied in non-invasive ways, x-rays are taken, ultrasound is taken. After the location of the abnormal course of the patient is established, the patient is sent for fistuloscopy.
For this procedure, the patient must be prepared. For 24 hours it is forbidden to eat, but you can drink water and other liquids.
Sometimes, for additional bowel cleansing, laxatives, an enema are prescribed 12 hours before the procedure.
Principles of conducting
Manipulations are carried out under sterile conditions, in the operating room or in the endoscopy room. The room must be equipped with X-ray or computer equipment. First, the patient is given local anesthesia or general anesthesia, the type of anesthesia depends on the severity of the disease and the condition of the patient, the goals of diagnosis.
Stages of fistuloscopy:
- The patient lies on the table. With internal fistulas, they take a position lying on their side, the legs are bent to the stomach. If external fistulas are being examined, the patient’s position will be chosen so that the clinician has easy access to the orifice (external outlet). An anesthetic injection is given.
- The skin or mucous membrane around the external mouth is treated with an antiseptic and covered with sterile wipes. To study internal formations, the same is carried out in the anus.
- The doctor inserts the endoscope tube into the area of interest: the anus or fistula opening. The procedure takes place under X-ray control or computer technology. The new generation equipment is equipped with a microcamera at the end of the endoscope, the image from it is transferred to the monitor. So the doctor sees the gradual advancement of the device and its environment.
- When examining through the rectum, gas is injected into it so that the walls of the organ straighten. The gas is safe for the patient, after the procedure it is pumped out. In this state, the intestines are easier to examine and detect the course of the fistula. After its detection, a thin fistuloscope is inserted into the hollow tube of the endoscope. With its help, the course of the fistula is washed and examined.
- If the detected orifice is less than 3 mm in diameter, it is impossible to examine it with a fistuloscope. Therefore, during the operation, selective fistulography is performed: the fistula cavity is filled with a contrast agent and a number of x-rays are taken. Also, during the examination, you can take a piece of material for analysis, do this with the help of miniature forceps.
- Upon completion, the instruments are removed, the endoscope insertion zone is once again treated with antiseptic preparations.
After the procedure, the patient is under the supervision of doctors for at least 3-4 hours if the disease is not complicated. With open fistulas, therapy is carried out in a hospital, so the patient remains in the hospital until a decent health adjustment.
Results of the study
Modern equipment makes it possible to study in detail the course and structure of the fistula, the causes of its occurrence, and ways to eliminate it. Also, in some cases, partial or complete treatment can be performed during fistuloscopy. Liquid, gas, instruments are supplied through the tube of the device. So, with the accumulation of biomass (blood, feces, mucus), the course of the fistula is washed with an antiseptic, which makes it easier to examine the area under study. In addition, the antiseptic sanitizes the fistula (cleansing), which reduces the inflammatory process.
If necessary, the doctor can fill the lumen, this is considered part of the treatment. A seal made of rapidly polymerizing materials is placed in the cavity of the passage, the composition of the seal also includes antibiotics. This procedure protects the internal organs from getting foreign masses into them, prevents infection and inflammation. When the intestine communicates with the gallbladder, they speak of a biliary fistula. The study of this phenomenon is combined with choledochoscopy – the diagnosis of the gallbladder.
Under such conditions, the examination becomes a medical procedure. If a stone is the cause of the fistula, it is removed with forceps through a tube, large stones are crushed and washed out.
The same is done when a ligature or bone sequester is found in soft tissues. Thus, the very cause of the disease is eliminated, and then therapy is prescribed for a full recovery.
When not to do fistuloscopy
Unfortunately, not all patients can receive such assistance, since not everyone can carry out an endoscopic examination. The study is contraindicated in such cases:
- the patient has decompensated diseases of the cardiovascular system;
- with severe diseases of the respiratory system;
- after myocardial infarction;
- the presence of intestinal adhesions;
- if the diameter of the inner or outer orifice is less than 3 mm;
- acute circulatory failure in the brain;
- in peritoneums.
Such manipulations are not carried out in the first 2 weeks after surgical interventions on the rectum or colon. If the patient has one of the contraindications, doctors decide how to replace fistulography. In rare cases, it is carried out for the purpose of treatment, even against the background of incompatible diseases, if this is vital for the patient.
Possible complications
Fistuloscopy has a high resolution, no other method provides such complete information about this disease. The procedure is almost painless, which is confirmed by the reviews of patients.
The whole process is controlled by specialists and computer installations. However, during its implementation there is a risk of failures and complications. The main and only complication is damage to the walls of the intestine or the fistula itself by the device.
The degree of damage is different, only the upper layer (mucous membrane, blood vessels) can suffer, in severe cases, perforation of organs and fistulas occur. This entails inflammation, infection, bleeding. Such complications are eliminated immediately during the procedure. In addition, after fistuloscopy or selective fistulography, pain sometimes occurs in the area of the abnormal course, such symptoms are considered normal and quickly pass.
Where is it held
A similar technology is carried out in clinics and in a hospital. The procedure is directed by a gastroenterologist, coloproctologist or surgeon. All manipulations for the introduction of devices and diagnostics will be carried out by an endoscopist in the presence of a surgeon and assistants. The examination takes place in sterile conditions, in an equipped room. Fistuloscopy services are provided by public institutions and private clinics. The cost of such a procedure in institutions of the private segment will be 400-550 dollars, if the condition is not complicated. The price of complex manipulations will be up to $ 2.
As you can see, fistuloscopy is an important examination method for patients with fistula. You should not be afraid of the procedure, it is carried out under anesthesia, sedation (healing sleep) or anesthesia. It allows you to accurately study the abnormal phenomenon and choose a successful treatment strategy, return the patient to a normal and full life.