Przetoki

Przetoki, in Polish medical terminology, refers to fistulas. A fistula (plural: przetoki) is a pathological, epithelium-lined passage that forms a connection between two surfaces inside the body, such as an organ and the skin, or two hollow organs. The term is used in clinical contexts to describe persistent tracts that drain rather than heal, often with two openings: an internal opening and an external opening.

Types and common examples include fistula-in-ano (anal fistula), which connects the anal canal to the surrounding skin; enterocutaneous fistulas that link the intestine to the skin; vesicovaginal fistulas between the bladder and the vagina; and other tracts arising from infections, surgery, trauma, or inflammatory diseases. Fistulas can be cryptoglandular, Crohn’s disease–associated, postoperative, radiation-induced, or related to infections or malignancies. The tract may drain mucus or pus and can be associated with pain, swelling, or recurrent infections.

Causes of przetoki vary and often depend on the location. They may originate from abscesses that fail to heal, inflammatory bowel disease (notably Crohn’s disease), surgical or traumatic injury, radiation therapy, or chronic infection. In some cases the cause remains unknown.

Diagnosis relies on clinical examination and imaging to delineate the tract. Methods include MRI or CT fistulography, endoscopy, ultrasound, and careful physical assessment to identify both internal and external openings.

Treatment aims to eradicate the fistula while preserving function, especially in anorectal cases. Approaches include surgical fistulotomy or fistulectomy, seton placement to drain and gradually cut through tissue, advancement flap procedures, or specialized techniques such as LIFT (ligation of the intersphincteric fistula tract). Management of underlying disease and infection, along with antibiotic therapy when indicated, is also important. Prognosis varies with fistula type, underlying condition, and the number of procedures required.