Sometimes we have to undergo major intestinal surgery, right? You may have heard that after such surgery, a small opening, called a `(stoma)`, is created on the surface of the stomach skin. It is normal to feel a little scared and nervous when you hear this. Today we are going to talk about something that is also a little complicated, but very important. That is, what is `Mucous Fistula` and why is it needed.
What is Mucous Fistula?
Simply put, a mucous fistula is a small opening created by surgically connecting a temporarily removed portion of your bowel to the skin of your abdomen.
Think about it, our intestines are not just a tube. They constantly produce a secretion called mucus to protect themselves and help things move easily. Now, let's imagine that a part of the intestine has been removed due to a medical condition, or that it has been separated from the rest of the body because it needs to rest. Then, that inactive part of the intestine continues to produce that mucus.
So, if these secretions have nowhere to go, they can accumulate in the intestines and cause pain, discomfort, and infection. What a mucous fistula does is create a way for those secretions to exit the body easily and safely.
Typically, you will have two openings (stomas) during this type of surgery.
1. The main stoma (Colostomy or Ileostomy): This is where digested food and stool come out. A bag is attached to this.
2. Mucous fistula: This is smaller than the other one. The mucous secretions we mentioned come out of this one.
Why do we need a mucous fistula?
This is usually done in conjunction with other bowel surgery. It may be necessary mainly for people with inflammatory bowel diseases (IBD). There are also several other reasons.
| Condition/Cause | A simple explanation |
|---|---|
| Crohn's disease and Ulcerative colitis | These are diseases that cause long-term inflammation of the intestines. This surgery is done to give the damaged part of the intestine time to heal. |
| Colorectal cancer | This method is used temporarily until parts of the intestine are reconnected after a cancerous tumor is removed. |
| Diverticulosis | Infection of small sac-like structures that grow out of the intestinal walls. |
| Intestinal obstructions or accidents | This method is used when a part of the intestine is blocked or damaged in an accident until it heals. |
Why do little babies need this?
Sometimes even newborn babies have to undergo this surgery.
- Imperforate anus: Some babies are born without an opening in the anus. This means that there is no way for stool to pass through. A temporary colostomy is created to allow stool to pass through and a mucous fistula is created to allow mucus to pass through until the baby is strong enough to undergo corrective surgery.
- Intestinal atresias: Some babies have blockages or disconnections in their intestines. If these cannot be repaired with a single operation, a temporary mucous fistula may be needed.
How is this surgery and the associated process going?
This is usually done by a colorectal surgeon who specializes in surgery of the large intestine or small intestine.
Before surgery
Your doctor will clearly explain to you what you need to do before surgery. These are usually the things you will need to do:
- Do not eat or drink anything for several hours before the surgery (fasting).
- Temporarily stop taking certain medications (especially those that reduce blood clotting) as directed by your doctor.
- If you smoke, it is essential to quit at least a few weeks before surgery. Smoking increases the risk of complications after surgery and delays wound healing.
- Empty and cleanse your intestines completely by drinking a special drink (bowel prep) given by your doctor.
During surgery
This surgery is done under general anesthesia. This means you won't feel anything, you'll be asleep. The surgeon will do the following:
1. An incision is made on the surface of the skin of the abdomen to reach the relevant part of the intestine.
2. The diseased part of the intestine or the part that needs to be rested is separated.
3. One end of the functional part of the intestine is connected to the main opening made in the abdomen (stoma). This is called an ileostomy or colostomy.
4. Another small opening is made and connected to one end of the disabled part of the intestine. This is the mucous fistula .
5. Then the main incision is sewn.
6. Special bags (ostomy bags) are attached to both openings.
Benefits, risks, and recovery time
Like any surgery, this one has both benefits and risks.
| Benefits | Possible risks |
|---|---|
| Prevent mucus from accumulating in the dysfunctional colon and allowing it to exit safely. | Infections or injuries to the skin around the opening. |
| Preventing pain, discomfort, and infection caused by mucus buildup. | The stoma may retract (retraction) or protrude (prolapse) from the skin. |
| Giving the damaged part of the intestine the rest it needs to heal. | Hernia around the opening. |
| Blood or mucus discharge from the rectum (Diversion proctitis). |
Recovery time
You will stay in the hospital for about a week after the surgery. During this time, the nursing staff will teach you how to clean and change your stomas and pouches, and how to care for the skin around them. At first, the stomas may look a little larger, darker, and moist, but over time they will shrink and flatten.
In the early stages, a mucous fistula may produce a lot of mucus . This is why a small bag may need to be worn over it. However, over time, this discharge will decrease significantly. Sometimes, it can be covered with a simple piece of gauze.
Is this permanent?
One of the biggest fears for many people is that this will be a lifelong condition. The good news is that in most cases, this is temporary. This is done to give the affected part of the intestine a break and a chance to heal. This healing process can take weeks, months, or even years. If your doctor decides to do so, they can surgically reconnect the part of the intestine and allow you to have normal bowel movements.
When to call a doctor immediately
After you go home, if you experience any of these symptoms, you should call your doctor immediately . Or go to the Emergency Department (ETU) of the nearest hospital.
- If there is blood in the stool.
- If you are bleeding excessively and unusually.
- If you experience frequent nausea and vomiting.
- If you have signs of infection, such as fever, chills, and shivering.
- If you have difficulty urinating or defecating (from the main stoma).
Living with a stoma can be challenging at first. But once you learn how to manage it, you can live a completely normal life. Be open with your doctor about any questions or concerns you may have.
Take-Home Message
- A mucous fistula is a protective opening that allows mucus produced by the dysfunctional part of the intestine to be removed from the body after intestinal surgery.
- This is usually done in conjunction with another major surgery (colostomy or ileostomy).
- In most cases, this is a temporary solution. Once the bowel has healed, it can be surgically restored to normal.
- It is very important to take good care of your stoma and the skin around it. The hospital will give you advice on this.
- If you experience unusual symptoms such as heavy bleeding, fever, or vomiting , contact your doctor immediately.
- Talk to your doctor about any concerns or questions you may have about this. They will be able to help you.
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