Proposed tuberculosis investigation and management protocol in complex and recurrent fistula-in-ano

Abstract

Background Tuberculosis (TB) is an ancient disease, endemic in some regions, caused by Mycobacterium tuberculosis. Among 22 countries accounting for 90% of tuberculosis cases worldwide, Brazil occupies the 17th place. The gastrointestinal form ranks sixth (5%) of extrapulmonary cases, while anorectal represents 2–7% of cases of fistula-in-ano, more common in midlife men, from endemic regions. In our country epidemiological data and accumulated clinical evidence strongly suggest the need for a systematic TB research as a responsible co-factor for complex anal fistulas or also those immunosuppression associated, in an attempt to reduce the high rates of recurrence of anal fistula (>30%). Purpose The course from a complex anal tuberculosis associated fistula, confirmed after initial suspicion of Crohn's disease, is presented in order to emphasize the relevance of suspicion and a diagnosis protocol, as well as healing criteria in fistulas contaminated by the bacilli. Discussion Sphincter damage risk in repeated fistula-in-ano surgical approaches requires considering tuberculosis infection, an underdiagnosed condition, and a preoperative diagnostic routine should be suggested. In the absence of description in the literature, preliminary clinical protocols must be provided in order to reduce recurrence and sphincter damage rates, when indicating surgical treatment of the disease.