versión On-line ISSN 2078-5151
versión impresa ISSN 0038-2361
S. Afr. j. surg. vol.47 no.4 Cape Town nov. 2009
Douglas StupartI; Paul GoldbergII; Anthony LevyIII; Dhiren GovenderIV
IM.B. CH.B., F.C.S; Colorectal Unit, Department of Surgery, University of Cape Town and Groote Schuur Hospital, Cape Town
IIM.B. CH.B., M.MED., F.C.S; Colorectal Unit, Department of Surgery, University of Cape Town and Groote Schuur Hospital, Cape Town
IIIM.B. CH.B., F.C.RAD; Department of Radiology, University of Cape Town and Groote Schuur Hospital
IVM.B. CH.B., F.F.PATH., F.R.C.PATH., M.MED., PH.D; Department of Pathology, University of Cape Town and Groote Schuur Hospital
INTRODUCTION: The aim of this study was to determine the prevalence of tuberculosis (TB) in anal fistulas at a referral hospital in Cape Town, and to document the clinical features and course of patients with tuberculous anal fistulas.
PATIENTS AND METHODS: This was a prospective study of all patients who underwent surgery for anal fistulas at the Colorectal Surgery Unit at Groote Schuur Hospital, Cape Town, from 2004 to 2006. Tissue was submitted for histopathological examination, Ziehl-Neelsen (ZN) staining and TB culture. The patients with proven TB were followed up until January 2008.
RESULTS: During the 3-year study period, 117 operations were performed on 96 patients. TB was diagnosed in 7 of the 96 patients (7.3%). In 5 of these 7 cases, the diagnosis of TB could be proven on histological examination and ZN staining, while in 2 cases the diagnosis could only be made on TB culture. None of the 7 patients had systemic features suggestive of TB, and only 1 had evidence of TB on a chest radiograph. Five patients were HIV-negative, and 2 declined testing. After a median follow-up of 2 years, 5 of 7 patients had evidence of recurrent or persistent fistulas, despite having completed 6 months of TB treatment.
CONCLUSION: At a referral hospital in an endemic area, TB was present in 7.3% of anal fistulas. Histopathological examination including ZN staining was inadequate to make the diagnosis in a third of these patients. Tissue from anal fistulas should therefore routinely be sent for TB culture as well as histopathological examination and ZN staining in areas where TB is prevalent.
“Full text available only in PDF format”
1. Sultan S, Azria F, Bauer P, Abdelnour M. Anoperineal tuberculosis. Diagnostic and management considerations in seven cases. Dis Colon Rectum 2002; 45(3): 407-410. [ Links ]
2. Kraemer M, Gill SS, Seow-Choen F. Tuberculous anal sepsis. Report of clinical features in 20 cases. Dis Colon Rectum 2000; 43(11): 1589-1591. [ Links ]
3. Shukla HS, Gupta SC, Singh G, Singh PA. Tubercular fistula in ano. Br J Surg 1998; 75(1): 38-39. [ Links ]
4. Marshal JB. Tuberculosis of the gastrointestinal tract and peritoneum. Am J Gastroenterol 1993; 88: 989-999. [ Links ]
5. Mehta JB, Dutt A, Harvill L, Mathews KM. Epidemiology of extrapulmonary tuberculosis. A comparative analysis with pre- AIDS era. Chest 1991; 99(5): 1134-1138. [ Links ]
6. den Boon S, van Lill SW, Borgdorff MW, et al. High prevalence of tuberculosis in previously treated patients, Cape Town, South Africa. Emerg Infect Dis 2007; 13(8):1189-1194. [ Links ]
7. Epstein D, Watermeyer G, Kirsch R. Review article: the diagnosis and management of Crohn's disease in populations with high- risk rates for tuberculosis. Aliment Pharmacol Ther 2007; 25(12): 1373-1388. [ Links ]
8. Seow- Choen F, Hay AJ, Heard S, Phillips RK. Bacteriology of anal fistula. Br J Surg 1992; 79(1): 27-28. [ Links ]
9. ShanY-S,Yan J-J, Sy ED, JinY-T, Lee J-C. Nested polymerase chain reaction in the diagnosis of negative Ziehl-Neelsen stained Mycobacterium tuberculosis fistula-in-ano. Report of four cases. Dis Colon Rectum 2002; 45(12): 1685-1688. [ Links ]