In June and July 2015, two of the patients with perianal abscesses and fistulas in my group were diagnosed with tuberculous perianal abscesses and fistulas half a month after surgery. What were the clinical manifestations after surgery that led me to consider them to be tuberculous? The main ones were afternoon hypothermia and progressive deepening and enlargement of the trauma. In order to draw the attention of my colleagues, the clinical features of these two patients are compiled below for sharing with you: Case 1 Zhao, a middle-aged male. He was admitted to the hospital in late June 2015 with “perianal abscess and anal fistula” due to “recurrent rupture of a paranal swelling with pus flow and pain for more than 10 years, aggravated for 10 days”. He had pleurisy 30 years ago, which is now healed. The patient was admitted to the hospital in late June 2015 with “perianal abscess and anal fistula”. Auxiliary examinations: ① Chest frontal and lateral DR: no substantial changes were seen in both lungs. On the day of admission, (right anterior) anal fistula excision + (left posterior) perianal abscess incision and ligature were performed. Postoperatively, antibiotics were routinely applied and herbal medicine was changed daily. After surgery, the patient had a persistent hypothermia with a temperature of 37.3° to 37.9°, reaching 38.5° on the third postoperative day, which was considered a postoperative reaction and was not treated at that time. Prior to anti-tuberculosis treatment, the body temperature was never below 37°. The patient had fatigue, night sweats, wasting, soreness and swelling in the anal surgical area, with a {red trabecular surface and a small mouth and large bottom shape of the trabecular cavity. On the 9th postoperative day, the rubber band hanging at the left posterior anal inflammatory block was dislodged, at which time the anal finger examination: the left posterior trauma cavity was deeper and larger than at the time of surgery (normally the trauma should have converged 9 days after surgery), and there was a tendency for the cavity to keep expanding. The right anterior anal fistula wound was also larger than that on the first postoperative day. The patient’s systemic symptoms and local signs were combined and the patient was sent to the provincial chest hospital for a tuberculin test, which was strongly positive (++++) at 72 hours, when the doctors at the provincial chest hospital admitted him to the hospital, and the patient’s family returned to our hospital for discharge. After anti-tuberculosis, nutritional support and daily anal flushing with water, the patient’s general condition gradually improved, and the anti-tuberculosis treatment was followed up in our department one week later, with normal body temperature, reduced malaise and significantly reduced anal trauma, and he was discharged from the chest hospital 14 days after staying there. The anal wound healed 40 days after surgery. The patient continued to take oral medication for anti-tuberculosis treatment. Case 2 Zhang, a young male, was admitted to the hospital with “high complex anal fistula” at the end of June 2015 due to “recurrent episodes of anal swelling and pus flowing for 2 years, aggravated for 6 months”. From 2013 to 2014, the patient underwent perianal abscess incision, fistula stitching and fistula excision three times at the local hospital. Specialized examination: in the ambulatory position, a surgical scar was visible in the left posterior anal region, an ulcer was visible at the scar, with a colored white thick discharge, and there was no stripe between the ulcer and the anus, and on finger palpation: there was a depression in the posterior anal region, with obvious pressure pain and a hard left middle to left posterior rectal ring. There was no blood staining in the regressed finger. Auxiliary examinations: ① Chest frontal and lateral DR: no substantial changes were seen in both lungs. ②Blood routine: WBC: 15.56×109/L. In early July 2015, a high complex anal fistula was performed in our hospital by incision and hanging, with postoperative application of antibiotics and routine dressing changes on the surgical wound. The patient had persistent postoperative hypothermia, with a rise in temperature starting at 1 pm every afternoon and reaching a maximum at 2 am, with a T of between 37,2° and 37,5°, and a temperature of 37° in the morning. The patient had malaise, night sweats, loss of appetite, and painful distention in the anal surgical area. The rubber band came off 12 days after surgery, and the local swelling was still sore after it came off (usually there is no obvious swelling and pain in the anus after the rubber band comes off), with the worst anal swelling at 2 or 3 am. The local surgical wound was not fresh and there was more thin secretion, and the trauma cavity in the fingertip area showed progressive expansion and deepening, and the trauma edge was curled and thinned inward. The patient was sent to the provincial chest hospital for tuberculin test, and the result was strongly positive (++) at 72 hours, confirming the diagnosis of tuberculous anal fistula. The patient’s body temperature was normal, and the symptoms of weakness and anal swelling gradually disappeared after the patient was treated with systemic anti-tuberculosis and nutritional support, and local rifampin was spread on a large butter gauze to change the medication, and the patient was discharged from hospital for 1 month after taking oral anti-tuberculosis medication back home. The above case gives us a hint: after hemorrhoid surgery, the trauma grows slowly and even expands progressively to check whether it is caused by tuberculosis infection. The fluctuating changes in body temperature and the localized soreness and swelling of the anus after surgery are all things that need to be observed. When observing the change in body temperature, we should take into account whether the decrease in the patient’s body temperature is due to anal pain after the application of painkillers and analgesic suppositories.