Mucous Fistula

What is a mucous fistula?

A mucous fistula attaches a disconnected part of your intestine to a surgically created small opening in the skin on your belly (stoma). This connection helps people with certain bowel diseases pass mucous (intestinal secretions) out of the stoma instead of the anus.

What do the intestines do?

Your small and large intestines (also called bowels) are part of your digestive system. Your small intestine has healthy bacteria that break down food so your body can absorb nutrients and fluids.

Partially digested food then enters your large intestine or colon. Here, bacteria continue to break down foods. Gas may form during this process. Your large intestine also absorbs water from foods and drinks, turning liquid waste into solid waste or poop. Your intestines make mucous to protect them from irritants like undigested food particles.

When do you need a mucous fistula?

People with inflammatory bowel diseases (IBDs) like Crohn’s disease and ulcerative colitis are most likely to need a mucous fistula. The procedure occurs during other surgeries to treat an IBD.

People with a mucous fistula have an ileostomy or colostomy where the digested foodstuffs come out through a different stoma. The reason your surgeon may make a mucus fistula is to prevent it from “blowing out” and leaking inside your belly. When done for ulcerative colitis or Crohn’s, it is most commonly an ileostomy and mucous fistula. When done for diverticulitis or sigmoid colon cancer, it is most commonly a colostomy and a mucous fistula.

Other conditions that may require a mucous fistula include:

• Colorectal (colon) cancer.
• Diverticulosis.
• Familial adenomatous polyposis.
• Intestinal injury or trauma.
• Large bowel (intestinal) obstruction.
• Small bowel obstruction.

Why do infants and children need a mucous fistula?

Infants and children may need a mucous fistula to treat:

• Imperforate anus: Some newborns don’t have an anal opening to pass stool. These infants need a colostomy and mucous fistula to temporarily treat this birth defect until they’re strong enough for corrective surgery.
• Intestinal atresias: Some babies have areas of blockage or discontinuity in their intestines when they are born called intestinal atresias. If these areas can’t be repaired in a single surgery, a mucous fistula may be needed.

Who performs a mucous fistula procedure?

A colorectal surgeon performs surgery on the digestive tract. You may also see a gastroenterologist, a medical doctor who specializes in the nonsurgical treatment of digestive tract diseases.

What procedures take place with a mucous fistula?

A mucous fistula procedure may occur at the same time as one of these surgeries:

• End colostomy: Your surgeon stitches one end of your large intestine into an opening in your abdominal skin, creating a stoma. When you look at a stoma, you see your intestinal lining. It looks pink and moist, like the inside of your cheek. A stoma doesn’t have nerves, so it isn’t painful or sensitive to touch. An ostomy pouch attaches to the stoma to collect stool.
• End ileostomy: Your surgeon connects the last part of your small intestine (the ileum) to a surgically created abdominal opening. An ileostomy often occurs after a colectomy (bowel resection surgery) to remove part or all of your large intestine. You pass stool through the stoma into an ostomy pouch.

With an end ileostomy or end colostomy, you have two stomas: a larger stoma for solid waste and a smaller opening for mucous (mucous fistula). When there are two stomas, the disconnected one is also known as the distal mucous fistula.

Initially, you may have a lot of mucus and need an ostomy appliance (bag) pouch on the mucous fistula stoma. This appliance is usually smaller than an ileostomy or colostomy appliance. The amount of mucus decreases over time. Eventually, you may simply cover the mucous fistula stoma with a piece of gauze. Some people get a stoma cap.

What happens before a mucous fistula procedure?

Your surgeon will tell you what you should and shouldn’t do before a mucous fistula procedure. In general, you may need to:

• Not eat or drink (fast) for a set number of hours before surgery.
• Stop taking certain prescriptions and over-the-counter medications.
• Try to quit smoking and using tobacco products like vapes or loose tobacco at least a few weeks before the procedure. Smoking raises the risk of surgical problems and slows the healing process.
• Use a prescription bowel prep to empty and clean out the bowels.

What happens during a mucous fistula procedure?

Digestive tract surgeries take place in a hospital. You receive general anesthesia to sleep through the procedure. A mucous fistula procedure takes place at the same time as a colostomy or ileostomy.

Your surgeon:

1. Makes an incision in your abdomen, disconnects the intestine and divides it into a proximal segment and a distal segment. The proximal segment will become the ileostomy or colostomy, and the distal segment will become the mucous fistula.
2. Brings each end of the divided intestines to surgically created abdominal openings.
3. Stitches the intestines to the openings on your skin, creating stomas.
4. Closes the main incision.
5. Attaches ostomy bags to the stomas.

Is a mucous fistula permanent?

In healthy people, a mucous fistula and the associated end ileostomy or colostomy are usually not permanent.

Your healthcare provider may recommend this temporary procedure to give your inflamed bowels time to rest and heal. The healing process may take weeks, months or years. When you’re ready, your surgeon can reconnect your intestine, allowing you to poop through your anus once again.

What are the benefits of a mucous fistula procedure?

A mucous fistula provides a way for your body to get rid of intestinal mucous, and secretions when you have an ileostomy or colostomy. Without a fistula, these substances can build up, causing abdominal pain and other problems.

What are the risks of a mucous fistula procedure?

You may experience these complications after a mucous fistula procedure:

• Mucus drainage.
• Diversion proctitis, which can lead to bleeding and blood clots passing from your rectum.
• Hernia.
• Infection.
• Separation of the stoma from your skin.
• Stoma retraction (stoma goes below the skin), prolapse (displaced stoma), stricture (narrowed stoma) or trauma.
• Sores or skin irritation due to friction from the pouch.
• Tissue death (necrosis) at the stoma site.

What is recovery like after a mucous fistula procedure?

You may spend up to one week in the hospital. During this time, a care team shows you how to care for the stomas and mucous fistula. You can expect some bruising and light bleeding. Initially, the stomas may look large, moist and dark, but they become smaller and flatter in time.

You may also expel lots of mucus through the mucous fistula. These problems lessen over time. You should follow your doctor’s recommendations for recovery, which may include not lifting heavy items until you heal. Sometimes anti-inflammatory suppositories can help decrease the discharge of blood and mucus from the mucous fistula.

When should I call my healthcare provider?

You should call your healthcare provider if you experience:

• Blood in stool.
• Difficulty peeing or pooping.
• Excessive bleeding.
• Nausea and vomiting.
• Signs of infection like fever or chills.

Are there alternatives to mucous fistulas?

You typically don’t need a mucous fistula if you get a loop ileostomy or loop colostomy and your surgeon can reconnect the bowel at the first operation. With these procedures, one end of the intestinal loop carries stool out of the stoma and into an ostomy pouch. The other end of the loop expels mucous out of the same stoma sort of like having the function of the mucus fistula built into the loop ileostomy or colostomy. You have one stoma and ostomy pouch.

Some people get a colostomy and Hartmann’s procedure instead of a mucous fistula. With this approach, your surgeon removes the last part of the colon (sigmoid colon) and creates an end colostomy for poop to exit the body. This disconnects the colon from the rectum and anus, forming a nonfunctioning rectal pouch.

A note from Cleveland Clinic

You may need a mucous fistula as part of surgical treatment for IBD, colon cancer or another digestive disease. A mucous fistula procedure takes place at the same time as a colostomy or ileostomy. Your surgeon brings a section of the large or small intestine to a surgically created opening in your abdominal skin. This is a stoma. A mucous fistula is a second stoma that allows your body to expel intestinal mucous. Having stomas can seem daunting. Talk to your doctor about your concern. Your care team can help you learn to care for and live a full life with a mucous fistula and stomas.