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KMID : 0356719960120010051
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Journal of the Korean Society of Coloproctology
1996 Volume.12 No. 1 p.51 ~ p.59
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Clinical Analysis of Tuberculous Anal Fistula
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Lim Seok-Won
Lee Chul-Ho
Lee Kwang-Ryul
Yoo Jung-Jun
Park Se-Young
Kim Hyun-Sik
Lee Jong-Kyun
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Abstract
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A 100 years ago, when the pathogenesis of anal fistulas could not be understood, the cause of anal fistulas was thought to be tuberculosis. However, now crypt glandular infection theory is accepted as their major cause. Nowadays, in Korea, the incidence of tuberculous anal fistula is reported to be below 5％ of their total number. In addition, the more the incidence of pulmonary tuberculosis decreases, the more the incidence of tuberculous anal fistulas decreases. The authors reviewed 65 confirmed tuberculous anal fistula cases from among a total of 1982 consecutive cases which were treated from January 1994 to June 1995 at Song Do Anorectal Hospital. The results are as follows: 1) Based on pathology results, tuberculous anal fistulas were present in 65 of the 1982 cases of anal fistulas (3.3%). 2) The male to female ratio for these 65 cases was 4:1, and the most prevalent age group was the 4th decade, followed by the 3rd decade, and 5th decade in that order. 3) According to Parks classification, intersphincteric fistulas were present in 50 of the 65 cases (77%), transsphincteric fistulas in 7 cases (11%), suprasphincteric fistulas in 7 cases (11％), and an extrasphincteric fistula in 1 case (2%). 4) Pulmonary tuberculosis was found in 41 of the 65 cases (63%), and 6 of these 41 cases involved active pulmonary tuberculosis (15%). 5) Tuberculous anal fistulas were suspected in only 25 of the 65 cases (38%) based
on their appearance during operation. Despite the decrease in the number of tuberculous anal fistulas with decreasing
pulmonary tuberculosis, tuberculous anal fistulas are not rare in Korea, and they are difficult to identify based on appearance only. Hence, we should be concerned about tuberculous anal fistulas and should confirm their presence by tissue pathology. In addition, to prevent recurrence, antituberculous medication should be given to the patient
for 9 months in order to destroy the tuberculous bacilli.
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KEYWORD
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Tuberculosis, Anal fistula
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