Complications and Extraintestinal Manifestations

Fistulas are small tunnels that can form through parts of your intestine. They can connect other sections of intestine, to the skin, or to other internal organs.

More than one-half of fistulas arise from the rectum. The most common type of fistula is called a perianal fistula, which opens in the area around the anus. Fistulas can also connect the rectum or intestine to other parts of the skin, to the bladder, or to the vagina.

Fistulas are associated with IBD inflammation. Better control of disease should mean a lower chance of fistulas in the future.
 

There are a few management options to consider if you have a fistula:

• Anti-TNF biologics, such as infliximab, can close fistulas, often permanently.

• Antibiotics, such as metronidazole or ciprofloxacin, can help to treat infection related to a fistula.

• Immunosuppressants, such as azathioprine or 6-mercaptopurine, may help but are less effective than biologics.

• Surgery may be required if the fistula is severe or complicated but is best avoided. 

• Local injection of stem cells has shown promise in recent trials, but is not available in Canada.

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Sometimes fistulas can burrow to the skin or to a blind end where fluid can accumulate in that tunnel. If the fluid becomes infected, it is called an abscess. This is very painful and can cause fever and spread to your bloodstream.

Fistulas located around the backside are commonly monitored using careful physical examination, ultrasound, or MRI to make sure there is no infection or abscess.

Sometimes abscesses are managed with antibiotics. In other cases, they may need to be treated with surgery to drain the infected fluid.