Incidence of Tuberculosis in Fistula in Ano in Northwest Part of Bangladesh, a Prospective Study of 50 Cases

Abstract

Background: Tuberculosis in the fistula in ano is extremely rare and has an important clinical entity, especially in cases where healing has not occurred despite proper multiple surgical interventions in developing countries like Bangladesh. Diagnosis of tuberculosis in the fistula is still a challenge in the modern era of medical science, even with the advancement of diagnostic modalities. Objectives: The purpose of this study was to determine the incidence of tuberculosis in fistulae- in-ano, with or without evidence of tuberculous foci elsewhere in the body and not responding to conventional surgical treatment. Materials and Methods: This is a prospective study of 50 cases of anal fistula admitted in the surgical unit of 250 Bed General Hospital, Thakurgaon during the period from March 2023 to February 2024. Tissue sent for histopathological examination, Ziehl-Neelsen staining and Tuberculosis culture. All data collected properly are evaluated by standard statistical methods. Result: Out of the 50 cases the majority were males (84%) and the majority of the patients belonged to the 40-60 years of age group. Maximum patients were from lower socio-economic conditions. Only 3(6%) patients are diagnosed with tubercular fistula-in-ano, all are male, and one was under anti-TB treatment previously. Three patients had fistulous tract containing multiple epithelioid cells and granuloma which is suggestive of tuberculosis. Conclusion: Tuberculosis should be suspected in all cases of complex and recurrent fistulae-in- ano. Meticulous clinical evaluation with 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. The treatment of tuberculous fistula in ano includes not only surgery but also ATT, which is the mainstay of treatment with an adequate duration, owing to the recurrent and relapsing nature of the disease and regular follow-up to cope up with recurrence.