title: Tubercular fistula-in-ano.
abstract: OBJECTIVE
  To determine the frequency of tuberculosis in recurrent fistula-in-ano.
  
  
  METHODS
  Case series.
  
  
  METHODS
  This study was conducted in Surgical Ward-3, Jinnah Postgraduate Medical Centre, Karachi, Pakistan, from 1998 to 2007.
  
  
  METHODS
  The study included 100 cases of recurrent fistula-in-ano not responding to conventional surgery. Patients with other co-morbidities such as diabetes mellitus, bleeding disorders or with the evidence of pulmonary, abdominal or intestinal tuberculosis were excluded from this study. Fistulogram was performed in all patients. All the patients were subjected to fistulectomy followed by histopathology of the resected specimen. Thereafter, confirmation of the disease, anti-tuberculous treatment was immediately started and response to treatment was observed after 6 months.
  
  
  RESULTS
  Out of the 100 studied patients, 11 cases had biopsy proven tuberculosis in the fistula. All the patients were male. The fistulae were low type, single and usually located posteriorly (n=9) with everted margins. Ten were located within 3 cm of anus. Fistulogram revealed single internal opening. Comparative statistics of tuberculous fistula-in-ano with fistulas due to specific inflammation revealed no major differences. The diagnosed patients of tubercular fistulae-in-ano were observed for at least 6 months after starting anti-tuberculous treatment. They all responded well to anti-tubercular treatment and the fistulae healed without any complication such as recurrence or anal stenosis within 6 months.
  
  
  CONCLUSIONS
  Tuberculosis should be suspected in case of recurrent fistulae-in-ano, so as to avoid unusual delay in the treatment and miseries to the patient. Appropriate anti-tuberculous therapy leads to healing within 6 months.
authors.affiliation: Department of General Surgery, Jinnah Postgraduate Medical Centre, Karachi. i_bokhari@hotmail.com
authors.forename: Iram
authors.initials: I
authors.lastname: Bokhari
authors.forename: Syed Sagheer Hussain
authors.initials: SS
authors.lastname: Shah
authors.lastname: Inamullah
authors.forename: Zahid
authors.initials: Z
authors.lastname: Mehmood
authors.forename: Syed Umer
authors.initials: SU
authors.lastname: Ali
authors.forename: Asadullah
authors.initials: A
authors.lastname: Khan