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What could be the cause of fistula in the small intestine?

Q: My 21 years old son joined the military last spring. He had some abdominal pain during that time that progressively got worse. Though he graduated basics but had a very bad day with the pain and nausea. The pain improved itself and then he went into tech school. During his first week the pain came back and grew severe enough that his teacher sent him to the hospital. The doctor immediately said that he had Crohn's disease. Another doctor delayed making a diagnosis and ordered a colonoscopy to scope his intestines. They discovered a couple of fistulas and prepared him for surgery. The surgeon found one loop of his intestine connected with two fistulas and removed that small section. The surgeon told me directly that the fistulas were a biological abnormality and he saw no evidence of Crohn's. The portion that was taken out was tested and found to be negative for Crohn’s. He has had no pain, diarrhoea and nausea since the surgery. Is it possible that the fistulas were caused by something other than Crohn's or irritable bowel syndrome (IBS) and truly were just a biological abnormality that once taken care will cause no problems? He had acute appendicitis less than two years before this occurred and had the surgery through three small incisions in his abdomen. The fistuals occurred on the same side as the appendix also. Other than this he has had no major illnesses except mono right after his appendicitis. Please advise.

A:Fistula in the small intestines and /or any other part of the digestive tract should be considered abnormal unless proved otherwise. I have never come across anything called biological fistula. Most intestinal fistulas occur either infective (as in Tuberculosis), inflammatory (as in Crohn's disease) or neoplastic (as in cancer). Your son had symptoms in the abdomen (pain & diarrhoea) and the endoscopy revealed the abnormality. In gastro-enterology practice it is generally accepted that in young people fistula is due to Crohn's disease but tuberculosis must be tested for and treated. Microscopic diagnosis, very rarely can be impossible in both conditions and the patient should be given the benefit of the doubt, i.e., get other tests done for TB and if all negative, still anti -TB treatment should be considered. As for Crohn's disease, if the person is well and has no symptoms he should be followed up by the specialist for a long time and regularly tested for Crohn's disease, as in my experience sometimes definitive diagnosis for Crohn's can be very difficult.

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