Ano-perianal tuberculosis: 15 years of clinical experiences in Southern Taiwan.

Objective: Ano-perianal tuberculosis (TB) is a rare extrapulmonary form of the disease. Most publications are in case report form. We report our cohort retrospective study on ano-perianal TB, which is one of the very few original reports in the literature.

Methods: Over a period of 15 years (January 1992-December 2006), file records revealed cases with confirmed diagnosis of ano-perianal TB after screening from a total of 1251 patients with the diagnosis of TB from Chang Gung Memorial Hospital-Kaohsiung, Taiwan.

Results: This study recruited 17 patients (14 male patients and 3 female patients). The age ranged from 18 to 81 years with a mean age of 44.8 +/- 18.2 years. Thirteen patients had coexistent pulmonary TB (76.5%). Eight patients had at least one concomitant co-morbid illness (47.1%). The most common clinical manifestations were anal fistulae (n = 16). All patients who completed a full course of anti-mycobacterial treatment for at least 6 months after surgical intervention were cured without recurrence except for one patient who was lost to follow-up after 2 months of treatment. Seven of the nine patients with complicated fistulae needed longer anti-mycobacterium treatment duration (9-18 months).

Conclusions: Ano-perianal TB should be kept in mind for all patients with prolonged or repeatedly recurrent ano-perianal symptoms and signs such as complicated fistulae in an endemic TB area like Taiwan. Management strategy is with conventional anti-mycobacterium therapy for at least 6 months after surgery. An extension of the anti-mycobacterium treatment course to 9-18 months is mandatory for patients with complicated disease presentations.