help me to understand so I may explain fistulas

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Veteran Member

Date Joined Sep 2006
Total Posts : 2527
   Posted 10/7/2007 3:47 PM (GMT -7)   
I have a fistula and know it is basically a tunnel from my intestines to the surface of my skin (mine is enterocutaneous).  I know a fistula is different from a perforation but I dont understand what the outside of the fistula tunnel is made from causing the contents not to leak elsewhere into my abdomen.  My medical dictionary I have from a vet course I took online...u still get a basic medical dictionary same for ppl and furpeople. 
My husband is wondering what that fistula tunnel is made from too and I have no way of explaining it since I dont know myself.  I am having more pain today than I have had since Thursday.  I still have gas coming out of the fistula area but not a large amount of feces.  I removed the wound drainage bag I had on sicne thursday and noticed that the hole has gone down to about half its size, when cleaning the hole out I actually felt some tension while trying to get the qtip down into the depth of it.  It was as if some crust was blocking the area.  For tonight I went back to the gauze just to see if it helps at all. 
Well now that I took some pain meds about 30 mins ago...first time since Friday morning.  I think I have a combo why I am really feeling crummy in general this weekend.  First the pain thru the week, CT scan, waiting for results...had my first Hep B vaccine done Wednesday...Had my 2nd loading dose of humira Friday night.  Also this weekend I am watiching my parents dogs which puts an added stress on me not to mention a halloween party in 2 weeks that I still need to make a costume for my hubby...My degree is in costume design...I need to cut out 3 more parts of it then sew it all which that part will take me no time at all.  For me I decided I am going to use one of my costumes that I used for a party a cpl yrs ago that my family hasnt seen that way there is less I have to do.  Then the day after the halloween party we are moving to my papa's the moving company is coming Sunday the 28th.  We hope by then we will have the cox installed so we have cable and net in the house.  At least we dont have to worry about moving things ourself just packing stuff up.  Last week I packed 3 bins I have 2 empty ones in my car and since my hubby has to work tomorrow I may run to walmart and get some more bins and some trash bags (the big ones since I only have kitchen sized ones here)
Okay so I went off on a tangent but really if anyone can answer my question it would be very helpful or at least a website that can give more info on what that tunnel like fistula is made of so the feces doesnt leak freely in the belly
Dx with Crohn's 1987, symptoms as early as 1984.
Temp iliostomy February 2007, reversed June 2007, Ovarian cysts, migraines, allergies (incl food allergies) , oral allergy syndrome (diff than true food allergies), Asthma, Gall Bladder removed 1999, Inguenal hernia 1987

Veteran Member

Date Joined Oct 2006
Total Posts : 2079
   Posted 10/7/2007 6:06 PM (GMT -7)   
You've asked a good question; something I haven't thought about even though I have fistulizing disease. I've just figured it's made up of scar tissue, but what type of tissue specifically, I don't really know. I remember my surgeon telling me he removed a mass of tissue connecting my vaginal wall to my colon, which he believed to be a fistula that hadn't broken through to the vagina yet, and I came away with the impression that it was like other type of abdominal scar tissue. I never saw the pathology report on it. Wished I had now.

That would be a good question to ask your GI. I'd really like to know too. Maybe someone here knows.

48 yr. old. Ileocolitis.  CD since early teens, misdx'd until age 36.  Hemicolectomy-left side in 2001.  Disease returned in 2003. Arthritis, episcleritis, chronic pain due to surgeries (nerve damage, adhesions) and disease.  Recently dx'd scoliosis.  History of endometriosis.

Post Edited (JaSanne) : 10/7/2007 7:09:54 PM (GMT-6)

Veteran Member

Date Joined Feb 2007
Total Posts : 1010
   Posted 10/7/2007 6:25 PM (GMT -7)   
Isn't a fistula a communication between two separate things (skin to intestine; intestine to intestine; intestine to bladder etc) So I don't think there is a tunnel. I think that the intestine has attached itself to the abdomenal wall and the fistula is the opening through the skin. I think fistulas often form when an abscess breaks open. When the infection and inflammation are in contact with another organ (skin, bladder, vagina, etc) he two get glued together and then a fistula forms. Sometimes the abscess or ulceration breaks into the peritoneal cavity then it is a free perforation. I hope someone who has a clearer understanding comes along that can explain better, cause that's the best i can do.

30+ years living with Crohn's.

New Member

Date Joined Oct 2007
Total Posts : 7
   Posted 10/7/2007 7:25 PM (GMT -7)   
I don't have the answer, but am interested in what others have to say.  I myself was just diagnosed with a complex fistula within the last month... They are more than the bowel touching some other organ and attaching itself.  I was told that the one openning I have in the skin branches off into 3 separate tracts, two of which are connecting to the rectum.  The other one apparently hasn't made it through yet?

Crohn's Disease dx February 1995
April 1995 - first resection due to perforation
November 2005 - subtotalcolectomy due to stricture in sigmoid
January 2007 - surgery for blockage due to adhesions
September 2007 - fistula... not sure what to think yet... sucky!
current meds - Entocort, Imuran, Cipro, Flagyl, Prilosec, Hyoscyamine (for bowel spasms), and Remicade very soon

Veteran Member

Date Joined May 2005
Total Posts : 4219
   Posted 10/7/2007 7:30 PM (GMT -7)   
Dragonfly- I dont know anything about fistulas but I just had a question about you cleaning yours w/ a q-tip and feeling "resistance." Isn't your goal for your fistula to close? If so, wouldn't cleaning it w/ a qtip keep re-opening it and not allowing it to heal? Im just curious.
25 Year old married female.  Diagnosed w/ CD 2 years ago, IBS for over 10 years before that, which was probably the CD.
I started getting a ton of junkmail after putting my myspace profile link on here.  Im taking it off but if you want to contact me just email me and Ill give you a link to my myspace.  Sorry!

Elite Member

Date Joined Apr 2005
Total Posts : 14995
   Posted 10/8/2007 6:41 AM (GMT -7)   
I am not 100% sure myself, but I think it is adhesion/scar tissue that creates the fistula. And I agree with Fitzy, I think you shouldn't really be poking at it with a q-tip. Wouldn't that just cause it to re-open. What about getting a squirt bottle and gently rinsing out the area with warm water?
Been living with Crohn's Disease for 32 years.  Currently on Asacol, Prilosec 60 mg, Estrace, Prinivil, Diltiazem, Percoset prn for pain and Calcium.  Resections in 2002 and 2005.  Recently diagnosed with Fibromyalgia and doing tests to see if I have Inflammatory Arthritis or AS.

Veteran Member

Date Joined Sep 2006
Total Posts : 2527
   Posted 10/8/2007 10:08 AM (GMT -7)   
I do the qtip thing since there was like a dried pus barrier and I know that the depth is 3 cm and I was getting gas out but little stool. My Dr wants me to make sure that if it needs to drain that it is able to thats why he has me cleaning it that way and placing a corner of gauze in it so that it wont heal over with the fistula underneath causing another abscess under the skin
Dx with Crohn's 1987, symptoms as early as 1984.
Temp iliostomy February 2007, reversed June 2007, Ovarian cysts, migraines, allergies (incl food allergies) , oral allergy syndrome (diff than true food allergies), Asthma, Gall Bladder removed 1999, Inguenal hernia 1987

Regular Member

Date Joined Jan 2007
Total Posts : 67
   Posted 10/8/2007 11:19 AM (GMT -7)   

Hi Dragonfly,

Hope you are feeling better this week!  I can't answer your question about "what" the fistula is actually made of either, but it's a good question.

I was concerned about something you said though.  You said that  "...had my first Hep B vaccine done Wednesday...Had my 2nd loading dose of humira Friday night."   I thought I had read somewhere that getting any kind of vaccinations (except flu) while taking any of the biologic drugs (remi, humira, enbrel etc..) should be avoided.  Does your gi know, or was he/she the one that had you getting the hep B vaccine? 

Veteran Member

Date Joined Sep 2006
Total Posts : 2527
   Posted 10/8/2007 2:34 PM (GMT -7)   
For my job I had to get re-vaccinated for tetanus/dyptheria plus they want 2 tb tests within a yr so they planted another one on me. I called my GI before I had to go for the work physical tho to check about the tetanus and hep b if they were dead vaccines since those are the safe vaccines to have...I know I cannot have live vaccines. He said yes definitly get the Hep...I had the Tetanus back in 2000 but RI law in the healthcare field wants you to have one every 2 yrs so I wanted to make sure the combo tetanus was all dead and to check on the hep vaccine.

I had never had the hep vaccine before going to college since my GI at the time had me on imuran and said even if I got it it wouldnt take. My new GI said definitly get the HEP B esp since you will be working at a hospital and it is a dead vaccine. Then after reading about humira and complications if you have hep B that becomes active or if you aquire hep b while on humira it made really good sense to get it esp since death is one of the reactions listed if you have an outbreak of Hep B while on humira.

We get the vaccines at employee health which is also internal medicine at the hospital. I informed them of my CD that I am on humira and that my GI knows and wants me to get the hep B...I was able to sign a waiver if I wanted for the hep B vaccine. They told me that they do humira there too and they usually make the patient get the hep series b4 starting humira for RA (sorry but having a fistula plus severe CD related arthritis is a little more vital in speed in getting humira than RA). They said after getting the series I will need my titers redone do to the humira it may show that I still have no resistance so then they said in that case they would give me an additional booster then retest again 6 months down the line. They said with their RA patients that happens on occassion but typically will show titers after that booster after the 6 months if the bloods come back as no resistance.

So to answer your question vaccines are okay unless they are live vaccines. Our flu shots should be in the week of Oct 17th so I will be darn sure to get one of those too being that I work as a receptionist for a family med practice treating everything from prenatal, infant to geriatric patients. That is why we cannot get Flumist that is a live version of the flu vaccine
Dx with Crohn's 1987, symptoms as early as 1984.
Temp iliostomy February 2007, reversed June 2007, Ovarian cysts, migraines, allergies (incl food allergies) , oral allergy syndrome (diff than true food allergies), Asthma, Gall Bladder removed 1999, Inguenal hernia 1987

Regular Member

Date Joined Dec 2006
Total Posts : 371
   Posted 10/9/2007 4:48 AM (GMT -7)
Female Dx'ed with Crohns Disease in 1992
Been on every med for crohns that exists
Several Fistula surgeries
Dx'ed with Colon Rectal Cancer March 2007
Dx'ed with Stage 2 Vulvar VIN
On Chemo and Radiation for 6 weeks

Veteran Member

Date Joined Dec 2006
Total Posts : 1986
   Posted 10/9/2007 5:35 AM (GMT -7)   
In Crohn's disease, the inflammation goes through all the layers of the intestine and also can inflame any organ or structure that part of the intestine is next to or touching.

If you have a bad spot inside your intestine (caused by the CD), maybe starting with an ulcer, or perhaps a fissure, it can start a hole which eats through all the inflamed layers and into the next structure/organ. Sometimes it ends internally because there are no structures close enough or the structures around it aren't inflamed enough to burrow through, and it creates an abscess, which is just a little pocket of debris and infection. In time this abscess can cause inflammation also, and sometimes break through to another structure. Remember, skin is also an organ.

They can get complicated, branch out in different directions. I had a fissure from my anastamosis that created an abscess and fistulized throughout my  peritoneal fat layer.   They had to remove part of my peritoneum and graft another membrane to get blood flow to that part of my abdomen.  At one time, this fistula had broken through to the skin surface, but it "healed" with remicade and 6MP.  We didn't know I still had things brewing underneath, nothing showed up on any of the tests. 

This is a very simplified explanation for a complicated physiological breakdown because of the CD, but I hope it helps you understand a little better.


49 years old, CD since I was a child.    
Six resection surgeries, permanent ostomy, adverse reactions to Remicade finally off of Prednisone, back on 6MP, hoping for a long remission from this last surgery. 

Post Edited (JudyK89) : 10/9/2007 7:31:28 AM (GMT-6)

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