A colonoscopy with fistulotomy is a procedure that involves the insertion of a long, flexible camera into the rectum while someone is under sedation. This camera allows the doctor to view the inside of the large intestine, rectum, and part of the small intestine to check for changes or blockages that may be present. If a doctor sees an abnormal connection between two organs or tissues, they will perform a fistulotomy at the same time to open the space and allow for healing. The fistulotomy can be performed by excision of the tract and surrounding tissue, simple division of the tract, or gradual division and assisted drainage.