Fistula is a known complication of surgical procedures involving bowel resection, anastomoses, and extensive bowel dissection. Prior radiation itself may cause marked inflammatory disease of the bowel and ultimately may cause fistula. Tumour masses may become incarcerated and stuck in the pelvis. Tumour related fistula at such sites often produces drainage of the bowel content into the vagina or the bladder.

The use of steroids in the conservative management of bowel obstruction may be effective in the short term , but prolonged use may enhance the tendency to fistula formation.

The development of entero-cutaneous and entero-vaginal fistula in patients with advanced pelvic malignancy raises specific problems. If the fistula is discharging into the abdominal wall it can often be controlled by the use of appropriate stoma appliances. However, small bowel fistula are acidic and causes excoriation of the skin. If the fistula is discharging through the vagina it is particularly difficult to maintain body cleanliness. While small bowel fistula do not smell 'faecal' they are unpleasant, are continuous, and produce excoriation of the vulva with resultant dysuria.

Prior to surgery it is helpful to confirm the site of the fistula. Various issue need to be raised with the patient before embarking on such surgery. The various likely surgical procedures must be discussed including ileostomy and colostomy. It is usual to perform some sort of intestinal bypass procedure, short circuiting the site of the fistula.

Surgical procedures include resection and anastomosis. The segment of fistulous bowel is isolated and one end of this closed loop is brought out into the abdominal wall as a 'mucous fistula' which act as a safety valve for the closed loop but in reality discharges very little and shrivels away.

Unless death is imminent most women prefer to have fistula cleared up surgically.