Mucous fistula

Overview

Your small and large intestines, also known as the bowels, are key components of your digestive system. The small intestine contains beneficial bacteria that help break down food, allowing your body to absorb nutrients and fluids.

Partially digested food then moves into the large intestine or colon, where bacteria further break it down, potentially producing gas. The large intestine also absorbs water from food and drinks, converting liquid waste into solid waste or stool. To protect themselves from irritants like undigested food particles, your intestines produce mucus.

A mucous fistula connects a detached section of your intestine to a small, surgically created opening in the skin on your abdomen (stoma). This allows individuals with certain bowel diseases to expel mucus (intestinal secretions) through the stoma rather than the anus.

Mucous fistulas may be involved in surgeries like bowel resection, including colectomy, ileostomy, or colostomy. These procedures are often necessary for individuals with IBD, colon cancer, or other digestive disorders.

Reasons for undergoing the procedure

Individuals with Inflammatory Bowel Diseases (IBDs) such as Crohn’s disease and ulcerative colitis are the most likely to need a mucous fistula. This procedure typically takes place during surgeries aimed at treating an IBD.

Those with a mucous fistula will also have an ileostomy or colostomy, with digested food exiting through a separate stoma. Surgeons create a mucous fistula to prevent internal leakage, or “blowing out,” inside the abdomen. For ulcerative colitis or Crohn’s disease, an ileostomy and mucous fistula are most common. For diverticulitis or sigmoid colon cancer, a colostomy and mucous fistula are more typical.

Other conditions that may necessitate a mucous fistula include:

• Diverticulosis.
• Colorectal cancer.
• Familial adenomatous polyposis. 
• Trauma or injury to the intestines. 
• Large bowel or small bowel obstruction.
  

A mucous fistula in infants and kids may be necessary to treat:

• Imperforate anus: Some newborns are born without an anal opening to pass stool. These infants require a colostomy and mucous fistula as a temporary measure until they are strong enough for corrective surgery.
• Intestinal atresias: Some babies are born with blockages or gaps in their intestines, known as intestinal atresias. If these areas cannot be repaired in a single surgery, a mucous fistula may be necessary.

One of these procedures may be combined with a mucous fistula procedure:

• End colostomy: Your surgeon attaches one end of your large intestine to an opening in your abdominal skin, forming a stoma. The stoma, which looks pink and moist like the inside of your cheek, is actually the lining of your intestine. It doesn’t have nerves, so it isn’t painful or sensitive to touch. An ostomy pouch is connected to the stoma to collect stool.
• End ileostomy: After a colectomy, which involves removing part or all of your large intestine, your surgeon will connect the final segment of your small intestine (the ileum) to a surgically created opening in your abdomen. Stool then passes through this opening, known as a stoma, and collects in an ostomy pouch.

With either an end ileostomy or end colostomy, you may have two stomas: a larger stoma for solid waste and a smaller opening for mucus, known as a mucous fistula. The disconnected stoma is referred to as the distal mucous fistula. You might require an ostomy appliance (bag) pouch on the mucous fistula stoma at first if you have a lot of mucus. In comparison to an ileostomy or colostomy appliance, this one is often smaller. Mucus production diminishes with time. In the end, you might just wrap a piece of gauze over the mucous fistula stoma. Several people receive stoma caps.

Risks

The following side effects are possible following a mucous fistula procedure:

• Infection
• Drainage of mucus.
• Diversion proctitis, which may result in rectum bleeding and the passage of blood clots from the rectum.
• A hernia.
• Separation of the stoma from the skin.
• Retraction of the stoma (going below the skin), prolapse (displaced stoma), stricture (narrowed stoma), or trauma.
• Sores or skin irritation brought on by the pouch’s rubbing.
• Necrosis, or tissue death, at the stoma site.

Before the procedure

What you should and shouldn’t do before to a mucous fistula procedure will be discussed with you by your surgeon. As a rule, you might have to:

• Fasting for a specific number of hours before surgery.
• Quit using some over-the-counter and prescription drugs.
• At least a few weeks before to the surgery, try to give up smoking and using tobacco products like vapes or loose tobacco. Smoking hinders the healing process and increases the chance of surgical complications.
• To clear and empty the bowels, use a prescription bowel prep.

During the procedure

Hospitals perform procedures on the digestive tract. To put you to sleep during the process, general anesthesia is administered. Costomy or ileostomy procedures are performed concurrently with a mucous fistula operation.

Your surgeon perform the following: 

• Creates a cut in your belly, separates the intestine, and separates it into two sections: the proximal and the distal. The mucous fistula will develop from the distal segment, and the ileostomy or colostomy will develop from the proximal segment.
• Connects the ends of the split intestines to abdominal openings made during surgery.
• Creates stomas by attaching the intestines to openings in the skin.
• Seals the main incision.
• Secure ostomy bags to the stomas. 

Outcome

In healthy individuals, a mucous fistula along with the associated end ileostomy or colostomy is typically not a permanent solution. Your healthcare provider might suggest this temporary procedure to allow your inflamed bowels to rest and heal. It could take several weeks, months, or even years to heal. Your surgeon can reconnect your intestine when you’re ready, enabling you to poop through your anus once more.

You may spend up to a week in the hospital, where a care team will teach you how to manage the stomas and mucous fistula. Expect some bruising and light bleeding. Initially, the stomas may appear large, moist, and dark but will become smaller and flatter over time.

You might also expel a significant amount of mucus through the mucous fistula. These issues typically improve as you recover. Follow your doctor’s recovery recommendations, which may include avoiding heavy lifting until you are fully healed. In some cases, anti-inflammatory suppositories can help reduce blood and mucus discharge from the mucous fistula.