Kraemer M, Gill S S, Seow-Choen F
Department of Colorectal Surgery, Singapore General Hospital, Singapore.
Dis Colon Rectum. 2000 Nov;43(11):1589-91. doi: 10.1007/BF02236745.
Tuberculosis is a neglected cause of anal sepsis, often is not recognized, and therefore is not treated properly.
All patients were reviewed who had tuberculous anal sepsis diagnosed by histology reports of fistulectomy specimens or abscess scrapings from January 1990 to April 1999.
Twenty patients (median age, 53 years; 18 males) with anal tuberculous sepsis were identified. They presented with abscesses (n = 2), abscesses and fistulas (n = 6), or fistulas (n = 12). All patients had a long history of anal complaints (3 months to 20 years), for which 15 patients were operated on previously. Nearly all fistulas (17/18) were complex, and secondary tracks or additional complicating features were common, even at first presentation. Eight patients had active concurrent pulmonary tuberculosis, and six showed evidence of previous pulmonary tuberculosis. Six patients had no signs of concurrent or previous tuberculosis elsewhere. Recurrence was observed only in cases where tuberculosis was initially not recognized, and antitubercular treatment therefore was not started.
Contrary to views held previously, anal tubercular sepsis seems to have characteristic clinical features. It should be considered in cases of known pulmonary or extrapulmonary tuberculosis or if anal sepsis is persistent, recurrent, or complex in nature.
结核病是肛门脓毒症被忽视的病因，常未被识别，因此未得到恰当治疗。
回顾了1990年1月至1999年4月间所有经肛瘘切除术标本或脓肿刮除物组织学报告确诊为结核性肛门脓毒症的患者。
共识别出20例（中位年龄53岁；男性18例）肛门结核性脓毒症患者。他们表现为脓肿（2例）、脓肿合并肛瘘（6例）或肛瘘（12例）。所有患者均有长期肛门不适病史（3个月至20年），其中15例曾接受手术治疗。几乎所有肛瘘（17/18）都很复杂，即使在初次就诊时，继发通道或其他复杂特征也很常见。8例患者同时患有活动性肺结核，6例有既往肺结核证据。6例患者无其他部位并发或既往结核的迹象。仅在最初未识别出结核病且因此未开始抗结核治疗的病例中观察到复发。
与先前观点相反，肛门结核性脓毒症似乎具有特征性临床特征。在已知患有肺结核或肺外结核的病例中，或者如果肛门脓毒症持续、复发或性质复杂，均应考虑该病。
