IsaacHDXxx form2Isaac Rebirth

Fistula (フィステューラ Fisutūra) (also known as "Meat Ball" from the artbook) is a boss found in Caves and Catacombs from the original game. In Rebirth, however, it is found in the Cellar only.


Fistula's appearance is extremely grotesque-looking, made of pieces of rotten flesh (with red fleshy skins from the inside) sewn together with thick stitches to form a large sphere. It sports with several hair strings, warts, and holes. In Edmund's artwork (and including the one from Rebirth), a few Chargers can be seen peeking out from the holes.

Total HP: 60 (Large) + 4x15(Medium) +8x8(Small) = 184


Fistula large

Larger form.

It resembles Envy in how it behaves, beginning as a single entity before splitting into four smaller entities upon taking damage, which then each split into two with further damage. However, unlike Envy, when reduced to the lowest size, the sections become Chargers.
Fistula medium

Medium-sized form.

The smaller a piece becomes, the faster it moves around. Pieces can also collide with each other, which changes their direction. Because of this, it is recommended to leave bigger parts intact for as long as possible, and focus on one part at a time. That way, the movement of the parts is more predictable, making the parts easier to dodge. It is also advised to kill the Charger before moving onto the next part, if possible. 

Despite floating in the air, Fistula and its parts cannot move over Rocks. However, as of the Wrath of the Lamb expansion, it can move over Pits.

Fistula small

Smaller form.

Fistula appears regularly as a Mini-Boss starting from The Caves to Sheol. In The Caves and The Depths, it starts as two smaller entities, and in The Womb and Sheol, a whole Fistula appears.

Champion Variants

Dark Blue

Fisula Dark

Total HP: 75 (Large) + 3x18.75 (Medium) + 6x10(Small) = 191.25

In this form, it will initially split into three entities instead of four and will spawn Boom Flies and Red Boom Flies on death. This version of Fistula has slightly more health, is larger, and moves slower.


Eternal Fistula

Every time it splits, it shoots 8-way bullets. It also spawns Eternal Spitties on death.


  • As a miniboss, Fistula will not spawn a Charger or Boom Fly if the smallest part is killed above a pit.


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    Fistula in the Artbook.

    From the artbook, Chargers seem to peek out of the holes while Fistula's smaller parts move around.
  • Fistula appeared in the demo from the original game.
  • The tradition of fighting the boss with its parts breaking into smaller and smaller pieces is based on the arcade classic Asteroids.
  • A fistula is a medical condition in which organs and other bodily tissues are abnormally connected to each other.
  • The name "Fistula" is used for another enemy in another game by Edmund McMillen: a flash game called The C-Word on Newgrounds.
  • It is also notable that the background of Host, another one of Edmund's games, there is what appears to be a Fistula.
  • Fistula also slightly resembles a dead Dumpling, a creature from Edmund's old series The Badlands.
  • In older versions, Fistula used to shake while moving. Since the Wrath of the Lamb update, it no longer does so.


  • Using Mom's Bra on the first form can cause subsequent forms to get stuck behind rocks, making this boss unbeatable if the player cannot break the rocks. The same is true with Teratoma.
  • Using Mom's Pad on any form may cause it to become trapped in rocks making it impossible to defeat without destroying the rocks. The same is true about Teratoma.



Regular Bosses
BlastocystChubDaddy Long LegsDark OneDingleDuke of FliesThe FallenFistulaGeminiGurdyGurdy Jr.GurglingsThe HauntLarry Jr.LokiMama GurdyMask of InfamyMega FattyMega MawMonstroMr. FredPeepPinPolycephalusScolexTurdlingsWidow

Afterbirth: BrownieDangleLittle HornRag ManTurdlings
Afterbirth †: Big HornRag Mega
Antibirth-only: Baby PlumBeelzeblubChimeraGreat GideonHornfelThe RainmakerReap CreepRotgutThe ScourgeThe SirenTuff TwinsWormwood

Posthumous Bosses
The AdversaryThe Blighted OvumThe BloatThe CageCarrion QueenThe GateThe HollowThe HuskLokiiMonstro IITeratomaThe Wretched

Afterbirth: The ForsakenThe FrailThe Stain
Antibirth-only: The HereticThe PileThe Visage

Alternative Bosses

Afterbirth †: Sisters Vis

ConquestWarFamineDeathPestilenceHeadless Horseman
Final Bosses
???IsaacIt LivesThe LambMega SatanMomMom's HeartSatan

Afterbirth: HushUltra Greed
Afterbirth †: Delirium
Antibirth-only: The Witness

Seven Deadly Sins
Seven Super Deadly Sins
Super EnvySuper GluttonySuper GreedSuper LustSuper PrideSuper SlothSuper WrathUltra Pride
Angels / Demons
KrampusGabrielUrielFallen Angels
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