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What causes a fistula? After an abscess has been drained, a passage may remain between the anal gland and the skin, resulting in a fistula. If the gland does not heal, there will be persistent drainage through this passage. If the outside opening of the fistula heals first, a recurrent abscess may develop.
Fistulas may also form between the gut and the skin or between the gut and an abscess cavity. Rarely, fistulas arise between a vessel and the gut, resulting in profound GI bleeding, which is a surgical emergency. (See Etiology.) Most GI fistulas (75-85%) occur as a complication of abdominal surgery. However, 15-25% of fistulas evolve spontaneously and are usually the result of intra-abdominal inflammation or infection. Regardless of their cause, fistulas have a tremendous impact on patients and society.