Jejunal Fistula: Causes, Symptoms & Treatment

What Is a Jejunal Fistula?

A jejunal fistula is an abnormal channel or tunnel connecting the jejunum – the middle portion of the small intestine – to another hollow organ, a body cavity, or the outer skin. Because the jejunum plays a central role in nutrient absorption, such a fistula can have significant consequences for nutrition and fluid balance. Fistulas are classified as internal fistulas (e.g., connecting to another segment of the intestine or to the bladder) or external fistulas (connecting to the skin surface, known as enterocutaneous fistulas).

Causes

Jejunal fistulas can develop due to a variety of diseases and events:

• Crohn disease: A chronic inflammatory bowel disease that frequently leads to fistula formation.
• Postoperative complications: Anastomotic leaks following small bowel surgery are a common cause.
• Trauma: Abdominal injuries from accidents or penetrating wounds can create fistulas.
• Tumors: Malignant growths in the small intestine region can give rise to fistulous tracts.
• Radiation therapy: Irradiation of the abdominal area can damage intestinal tissue and lead to fistula formation.
• Abscesses: Intra-abdominal abscesses can erode into neighboring structures.

Symptoms

The symptoms of a jejunal fistula depend on the type and extent of the fistula. Typical signs include:

• Discharge of intestinal contents (stool, bile, digestive juices) through the fistula opening at the skin or into another organ
• Malnutrition and weight loss due to impaired nutrient absorption
• Electrolyte and fluid losses that can lead to dehydration
• Abdominal pain and a feeling of pressure
• Fever and signs of infection or sepsis in complicated cases
• Skin irritation and damage around the external fistula opening caused by aggressive digestive secretions

Diagnosis

Diagnosis of a jejunal fistula is made through a combination of clinical examination and imaging studies:

• Clinical examination: Inspection of the fistula opening, assessment of the discharge, and evaluation of the surrounding skin.
• Fistulography: X-ray examination with contrast medium to visualize the fistulous tract and its connections.
• Computed tomography (CT): Abdominal imaging to assess the course of the fistula, involved structures, and any associated abscesses.
• MRI (Magnetic resonance imaging): Particularly useful in Crohn disease for precise characterization of fistulous tracts.
• Endoscopy: Examination of the small intestine from within, for example using push enteroscopy.
• Laboratory tests: Blood count, inflammatory markers (CRP, white blood cells), electrolytes, and albumin to assess nutritional status.

Treatment

Treatment of a jejunal fistula depends on the underlying cause, the extent of the fistula, and the overall condition of the patient:

Conservative Treatment

• Nutritional therapy: Parenteral nutrition (intravenous feeding) or enteral nutrition via tubes to rest the bowel and improve nutritional status.
• Fluid and electrolyte replacement: Compensation of losses through intravenous infusions.
• Wound care: Protection of the skin around the fistula opening using specialized dressings and ostomy materials.
• Pharmacological therapy: In Crohn disease, immunosuppressants or biologics (e.g., TNF-alpha inhibitors) may be used to promote fistula closure.
• Somatostatin analogues: These can reduce intestinal secretion output and thereby support fistula closure.

Surgical Treatment

• Surgical excision of the fistula with resection of the affected bowel segment and subsequent intestinal anastomosis (reconnection of the bowel ends).
• In cases of significant inflammation or abscess, a staged approach may be required, initially involving the creation of a stoma.

Prognosis

The prognosis of a jejunal fistula depends greatly on the underlying cause, the nutritional status of the patient, and the presence of complications. Simple postoperative fistulas may close spontaneously with optimal conservative management. Fistulas associated with Crohn disease or radiation injury often require surgical intervention. Close interdisciplinary care involving gastroenterology, surgery, and nutritional medicine is essential for successful treatment outcomes.

References

1. Kumpf VJ et al. - ASPEN Clinical Guidelines: Support of Pediatric and Adult Patients With Enterocutaneous Fistula. JPEN J Parenter Enteral Nutr. 2017;41(1):104-112.
2. Bemelman WA et al. - Multidisciplinary Management of Enteric Fistulas. Diseases of the Colon and Rectum. 2010;53(9):1346-1349.
3. Townsend CM et al. - Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice. 21st edition. Elsevier, 2021.