Korean J Gastroenterol.  2013 Dec;62(6):370-374. 10.4166/kjg.2013.62.6.370.

A Case of Intestinal Tuberculosis with Perianal Fistula Diagnosed after 30 Years

• Cheon JH
• Moon W
• Park SJ
• Park MI
• Kim SE
• Choi YJ
• Kim JB
• Kwon HJ

• KMID: 1711294
• DOI: http://doi.org/10.4166/kjg.2013.62.6.370

Abstract

Tuberculosis can occur anywhere in the gastrointestinal tract. However, anorectal tuberculosis has rarely been reported. A 46-years-old male presented with abdominal pain and perianal discharge of 30 years' duration. The patient had received operations for anal fistula and inflammation three times. Although he had been taking mesalazine for the past three years after being diagnosed with Crohn's disease, his symptoms persisted. Colonoscopy performed at our hospital revealed cicatricial change of ileocecal valve and diffuse ulcer scar with mild luminal narrowing of the ascending, transverse, and descending colon without active lesions. Multiple large irregular active ulcers were observed in the distal sigmoid and proximal rectum. An anal fistula opening with much yellowish discharge and background ulcer scar was observed in the anal canal. However, cobble-stone appearance and pseudopolyposis were not present. Therefore, we clinically diagnosed him as having intestinal tuberculosis with anal fistula and prescribed antituberculosis medications. Follow-up colonoscopy performed 3 months later showed much improved multiple large irregular ulcers in the distal sigmoid colon and proximal rectum along with completely resolved anal fistula without evidence of pus discharge.

Keyword

Gastrointestinal tuberculosis; Crohn disease; Anal fistula

MeSH Terms

Anal Canal
Anti-Inflammatory Agents, Non-Steroidal/therapeutic use
Antitubercular Agents/therapeutic use
Colon/pathology
Colonoscopy
Crohn Disease/diagnosis/drug therapy
Diagnosis, Differential
Fistula/*diagnosis/pathology
Humans
Ileocecal Valve/physiopathology
Male
Mesalamine/therapeutic use
Middle Aged
Protein C/analysis
Tuberculosis, Gastrointestinal/*diagnosis/drug therapy
Anti-Inflammatory Agents, Non-Steroidal
Antitubercular Agents
Mesalamine
Protein C

Figure

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  Fig. 1. Initial colonoscopic findings. (A) The anal fistula opening (white arrow) and pus discharge are observed in the anal canal (black arrow).(B) Patulous ileocecal valve is observed. (C) Multiple large irregular active ulcers are observed in the distal sigmoid and proximal rectum.

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  Fig. 2. Microscopic finding. Ill-defined granuloma is seen in colonic tissue (H&E, ×200).

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  Fig. 3. Colonoscopic findings three months after antituberculosis medication. (A) The anal fistula opening is healed and only scar change (white arrow) is observed in the anal canal (black arrow). (B) Ileocecal valve has become more patulous compared with previous examination. (C) Active ulcers have completely been healed and scar change is observed in the distal sigmoid and proximal rectum.

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