{"id":12766,"date":"2025-07-24T10:34:51","date_gmt":"2025-07-24T14:34:51","guid":{"rendered":"https:\/\/www.rigicon.com\/glossary-term\/fistula\/"},"modified":"2026-10-06T12:50:55","modified_gmt":"2026-10-06T16:50:55","slug":"fistula","status":"publish","type":"glossary-term","link":"https:\/\/www.rigicon.com\/pt-br\/glossary-term\/fistula\/","title":{"rendered":"F\u00edstula"},"content":{"rendered":"","protected":false},"excerpt":{"rendered":"","protected":false},"featured_media":0,"template":"","glossary-category":[127],"glossary-product":[],"class_list":["post-12766","glossary-term","type-glossary-term","status-publish","hentry","glossary-category-surgical-complications"],"acf":{"gt-definition":"<p>A f\u00edstula \u00e9 uma conex\u00e3o anormal entre duas superf\u00edcies epitelizadas ou partes do corpo que normalmente n\u00e3o se conectam.<sup class=\"citation\">1<\/sup> Esse trajeto patol\u00f3gico pode se formar entre quaisquer dois espa\u00e7os ocos, incluindo vasos sangu\u00edneos, intestino, vagina, bexiga e pele.<sup class=\"citation\">2<\/sup> As f\u00edstulas s\u00e3o classificadas de tr\u00eas maneiras diferentes: anat\u00f4mica, fisiol\u00f3gica e etiologicamente.<sup class=\"citation\">2<\/sup><\/p>\n\n<p>Anatomicamente, as f\u00edstulas s\u00e3o subdivididas em duas categorias:<\/p>\n<ul>\n    <li><strong>F\u00edstulas internas<\/strong>: conex\u00f5es entre duas estruturas internas (por exemplo, enteroc\u00f3lica, ileossigmoide, aortoent\u00e9rica)<sup class=\"citation\">2<\/sup><\/li>\n    <li><strong>F\u00edstulas externas<\/strong>: conex\u00f5es entre uma estrutura interna e uma estrutura externa (por exemplo, enterocut\u00e2nea, enteroatmosf\u00e9rica, retovaginal)<sup class=\"citation\">2<\/sup><\/li>\n<\/ul>\n\n<p>Quando classificadas fisiologicamente, as f\u00edstulas s\u00e3o diferenciadas com base no d\u00e9bito de l\u00edquido:<\/p>\n<ul>\n    <li><strong>F\u00edstulas de baixo d\u00e9bito<\/strong>: drenam menos de 200 ml de l\u00edquido por dia<sup class=\"citation\">2<\/sup><\/li>\n    <li><strong>F\u00edstulas de m\u00e9dio d\u00e9bito<\/strong>: drenam entre 200-500 ml de l\u00edquido por dia<sup class=\"citation\">2<\/sup><\/li>\n    <li><strong>F\u00edstulas de alto d\u00e9bito<\/strong>: drenam mais de 500 ml de l\u00edquido por dia<sup class=\"citation\">2<\/sup><\/li>\n<\/ul>\n\n<p>Etiologicamente, as f\u00edstulas s\u00e3o classificadas com base em sua causa, sendo as categorias comuns as f\u00edstulas traum\u00e1ticas, as f\u00edstulas de s\u00edtio cir\u00fargico e as f\u00edstulas associadas a condi\u00e7\u00f5es inflamat\u00f3rias, como a doen\u00e7a de Crohn.<sup class=\"citation\">2<\/sup><\/p>","gt-synonyms":"Passagem anormal, conex\u00e3o patol\u00f3gica, trato sinusal, trato anormal, trato fistuloso, trato epitelizado, ducto patol\u00f3gico, comunica\u00e7\u00e3o anormal","gt-citation":"[1] Sohrabi M, Bahrami S, Mosalli M, Khaleghian M, Obaidinia M. Perianal Fistula; from Etiology to Treatment - A Review. Middle East J Dig Dis. 2024 Apr 30;16(2):76-85. DOI: 10.34172\/mejdd.2024.373\n\n[2] Cowan KB, Cassaro S. Enterocutaneous Fistula. StatPearls [Internet]. 2023 Aug 7. PMID: 29083609. https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK459129\/\n\n[3] Carr S, Velasco AL. Fistula-in-Ano (Archived). StatPearls [Internet]. 2023 Jul 31. PMID: 32491449. https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK557517\/\n\n[4] Wang H, Fei B, Jin H. Complex anal fistula: A case report. International Journal of Surgery Case Reports. 2020;77:782-786. DOI: 10.1016\/j.ijscr.2020.11.056\n\n[5] Zhao WW, Yu J, Shu J, et al. Precise and comprehensive evaluation of perianal fistulas, classification and related complications using magnetic resonance imaging. Am J Transl Res. 2023;15(5):3674-3685. PMID: 37303685","gt-clinical-context":"<p>As f\u00edstulas podem ocorrer em muitas partes do corpo e se formar entre diversas estruturas.<sup class=\"citation\">3<\/sup> Elas resultam, mais comumente, de infec\u00e7\u00e3o, inflama\u00e7\u00e3o, trauma ou como complica\u00e7\u00e3o de cirurgia.<sup class=\"citation\">1,2<\/sup> A apresenta\u00e7\u00e3o cl\u00ednica varia de acordo com a localiza\u00e7\u00e3o e o tipo de f\u00edstula.<\/p>\n\n<h3>F\u00edstulas perianais\/anais<\/h3>\n<p>A f\u00edstula anal (fistula-in-ano) \u00e9 um trajeto que conecta o canal anal \u00e0 pele perianal.<sup class=\"citation\">3<\/sup> Requer tratamento cir\u00fargico na maioria dos casos. O manejo adequado melhora a qualidade de vida do paciente.<sup class=\"citation\">3<\/sup> As f\u00edstulas anais resultam comumente de um abscesso anorretal, sendo que 30% a 70% dos pacientes com abscesso anorretal apresentam uma f\u00edstula anal concomitante.<sup class=\"citation\">1<\/sup> A classifica\u00e7\u00e3o das f\u00edstulas anais baseia-se na anatomia, especificamente em rela\u00e7\u00e3o ao complexo esfincteriano:<\/p>\n\n<ul>\n    <li><strong>Interesfincteriana (45%)<\/strong>: a f\u00edstula atravessa o esf\u00edncter interno, mas poupa o esf\u00edncter externo<sup class=\"citation\">3<\/sup><\/li>\n    <li><strong>Transesfincteriana (30%)<\/strong>: a f\u00edstula atravessa tanto o esf\u00edncter interno quanto o externo<sup class=\"citation\">3<\/sup><\/li>\n    <li><strong>Supraesfincteriana (20%)<\/strong>: a f\u00edstula atravessa o esf\u00edncter interno e, em seguida, estende-se superiormente no plano entre os esf\u00edncteres, passando acima do esf\u00edncter externo antes de se estender at\u00e9 o per\u00edneo<sup class=\"citation\">3<\/sup><\/li>\n    <li><strong>Extraesfincteriana (5%)<\/strong>: essa f\u00edstula rara forma uma conex\u00e3o do reto ao per\u00edneo que se estende lateralmente aos esf\u00edncteres interno e externo<sup class=\"citation\">3<\/sup><\/li>\n<\/ul>\n\n<h3>F\u00edstulas enterocut\u00e2neas<\/h3>\n<p>S\u00e3o conex\u00f5es anormais entre o trato gastrointestinal e a pele.<sup class=\"citation\">2<\/sup> S\u00e3o classificadas fisiologicamente com base no volume de d\u00e9bito, e as estrat\u00e9gias de manejo variam de acordo. Os pacientes apresentam alto risco de desequil\u00edbrios eletrol\u00edticos, sepse e desnutri\u00e7\u00e3o, o que torna a estabiliza\u00e7\u00e3o o primeiro passo do manejo.<sup class=\"citation\">2<\/sup><\/p>\n\n<h3>Outros tipos<\/h3>\n<ul>\n    <li>F\u00edstulas arteriovenosas (entre uma art\u00e9ria e uma veia)<\/li>\n    <li>F\u00edstulas biliares (decorrentes de cirurgia da ves\u00edcula biliar)<\/li>\n    <li>F\u00edstulas cervicovaginais<\/li>\n    <li>F\u00edstulas vesicovaginais (entre a bexiga e a vagina)<\/li>\n    <li>F\u00edstulas traqueoesof\u00e1gicas<\/li>\n    <li>F\u00edstulas aortoent\u00e9ricas<\/li>\n<\/ul>\n\n<p>O diagn\u00f3stico normalmente envolve exame f\u00edsico, exames de imagem (RM, ultrassonografia endoanal, fistulografia, TC) e, \u00e0s vezes, exame sob anestesia.<sup class=\"citation\">3,5<\/sup> A RM \u00e9 considerada a modalidade de imagem mais sens\u00edvel (&gt;90%) para a avalia\u00e7\u00e3o de f\u00edstulas.<sup class=\"citation\">3<\/sup><\/p>\n\n<p>As abordagens de tratamento variam de acordo com o tipo, a localiza\u00e7\u00e3o e a causa subjacente da f\u00edstula. O manejo cir\u00fargico \u00e9 a base do tratamento da maioria das f\u00edstulas, em especial das f\u00edstulas anais.<sup class=\"citation\">1,3<\/sup> O tratamento cl\u00ednico pode ser considerado em determinadas situa\u00e7\u00f5es, especialmente nas f\u00edstulas associadas \u00e0 doen\u00e7a inflamat\u00f3ria intestinal.<sup class=\"citation\">1<\/sup> Os principais objetivos do tratamento s\u00e3o controlar a infec\u00e7\u00e3o, assegurar a preserva\u00e7\u00e3o funcional (como a contin\u00eancia fecal nas f\u00edstulas anais) e melhorar a qualidade de vida.<sup class=\"citation\">1,3<\/sup><\/p>","gt-related-evidence":null,"gt-featured":true,"gt-ai-referenced":false,"gt-view-count":114},"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v28.6 (Yoast SEO v28.7) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>F\u00edstula Urol\u00f3gica: Tipos e Tratamento | Rigicon<\/title>\n<meta name=\"description\" content=\"Conhe\u00e7a as f\u00edstulas urol\u00f3gicas: comunica\u00e7\u00f5es anormais entre o trato urin\u00e1rio e estruturas adjacentes. 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