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December 3, 1938


JAMA. 1938;111(23):2095-2101. doi:10.1001/jama.1938.02790490025006

Intestinal fistula may be defined as an abnormal communication between a portion of the intestinal tract and a hollow abdominal viscus (internal fistula) or between a segment of the intestine and surface of the body (external fistula).

CLASSIFICATION AND ETIOLOGY  From an etiologic standpoint, intestinal fistulas may be placed in two general groups: (1) those which are intentionally established by such operations as colostomy, enterostomy or appendicostomy and (2) those which are produced by some pathologic process or by trauma, for example actinomycosis, tuberculosis, regional enteritis, a malignant condition, gunshot or penetrating wounds or surgical accidents. The fistulas which arise as a result of inflammatory disease are most frequently the sequelae of appendicitis, diverticulitis and pelvic inflammatory processes. Similar classifications have been suggested by Rigby1 and Coffey.2In a review of 109 cases of fecal fistula collected from the records of Johns Hopkins Hospital from 1891 to 1931,

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