Abdominal actinomycosis

Exploring the link between long-term intrauterine contraceptive device usage and abdominal actinomycosis in a middle-aged female: A case report

Actinomycosis is a rare, chronic, and suppurative disease caused by Actinomyces species, which are filamentous, obligate, Gram-positive bacteria. This report presents a case of anterior abdominal actinomycosis in a 40-year-old female with a history of intrauterine contraceptive device placement. The patient presented with severe abdominal pain, an abdominal mass, low-grade fever, and weight loss. Imaging studies revealed thickening of the left rectus abdominis muscle and pericolic fat stranding. An exploratory laparotomy confirmed dense adhesions from the transverse colon and omentum to the abdominal wall with a purulent discharge. Resection of the affected colon segment and primary anastomosis were performed. Histopathological examination revealed characteristic colonies of Actinomyces within abscesses, confirming the diagnosis of actinomycosis. The patient received appropriate antibiotic therapy and showed improvement. This case highlights the rare occurrence of abdominal wall actinomycosis associated with an intrauterine contraceptive device and emphasizes the importance of considering actinomycosis in the differential diagnosis of abdominal pathologies. Thus, medical history related to intrauterine contraceptive device use should be regarded as in differentials if a patient presents vague abdominal mass and pain, and small details in history should be emphasized and looked upon so that a timely decision can be made for the betterment of the patient.

A Rare Complication of Actinomyces Abdominal Infection: A Case Report

Intraabdominal infection by Actinomyces species, although a rare condition, usually occurs after a disruption of the mucosal barrier in a peritoneal organ. This infection is characterized by the development of an extended and persistent inflammatory and fibrotic reaction that can be mistaken for other pathogens or different etiologies, like tumors or inflammatory diseases. It can present as an abscess, a stricturing tissue with multiple adhesions, and/or a fistulization. Early diagnosis, targeted and prolonged antimicrobial therapy, and optimal drainage when indicated, are the key to success. The authors present a case where laparotomic hysterectomy was complicated by a superficial and an organ/space surgical site infection due to Actinomyces with a posterior developing of a colo-vaginal fistula that was treated surgically.

Urinary Actinomyces infection with a urachal remnant

Urinary Gram staining is helpful in patients with complicated urinary retention, such as prolonged urinary retention and coexisting ureteral retention disease. If gram-positive rods are observed on urine Gram staining in a patient with urinary tract infection, an anaerobic culture of the urine may be helpful for early diagnosis and treatment of Actinomyces infection.

Pelvi-abdominal as a complication of long-term use of intrauterine device (IUD). The important role of imaging in diagnosis and follow-up

ACTINOMYCOSIS is a rare chronic granulomatous disease caused by anaerobic filamentous gram-positive bacteria, the most common of which is Actinomyces israelii. Actinomycetes are commensal inhabitants of the oral cavity and gastrointestinal tract, but they may become pathogenic through invasion of breached or necrotic tissue. Pelviabdominal ACTINOMYCOSIS is uncommon and can mimic a variety of disease processes, including abdominal mass mimicking malignancy, acute abdomen, asthenia, and weight loss. We describe a 38-year-old woman who presented with acute abdominal pain and tenderness, as well as constitutional manifestations and elevated inflammatory markers. On initial computerized tomography (CT) and MRI, a large fluid collection underlining the anterior abdominal wall at the false pelvic cavity, as well as parietal peritoneal enhancement and smudging of the mesenteric fat and a bulky fibroid uterus with an implanted IUD, were identified. The ultrasound guided aspiration and anaerobic culture revealed positive growth for Actinomyces bacteria. An exploratory laparoscopy revealed extensive adhesions between the abdominal wall and the small intestine, as well as hyperemic and thickened peritoneum, and peritoneal biopsy confirmed ACTINOMYCOSIS. After the diagnosis was established, the IUD was removed and the patient was given Ceftriaxone 2 gm once daily for 6 weeks before switching to oral doxycycline 100 mg twice daily for another 3 months. A significant regression of the suprapubic fluid collection, and peritoneal-mesenteric changes were confirmed on follow-up. The case is discussed, and the relevant literature reviewed and analyzed.

An 82-year-old man with a prosthetic aortic valve and multimicrobial bacteremia

The patient is an 82-year-old male with a past medical history of aortic valve replacement who presented to the emergency department after a fall. He developed atrial fibrillation with a rapid ventricular response and non-ST-segment-elevation myocardial infarction, leading to hospitalization. During hospital admission, the patient complained of midline thoracic back pain, and an extensive evaluation for this complaint revealed discitis and osteomyelitis with epidural abscess near the T7 and T8 vertebrae that did not result in neurological deficits and required no surgical intervention. A total of 2 blood cultures were reported positive for Actinomyces naeslundii, Streptococcus mitis, Streptococcus oralis, and Abiotrophia defectiva. A transesophageal echocardiogram showed a small vegetation on the aortic prosthetic valve with probable small vegetation on the mitral valve. He was prescribed ceftriaxone intravenously for 12 weeks, followed by amoxicillin 2 g orally twice a day for at least 12 months. A. naeslundii is not commonly known to cause infective endocarditis, whereas S. mitis, S. oralis, and A. defectiva have been reported to do so. One previous case of A. naeslundii was reported to cause prosthetic valve endocarditis as a single infectious agent. To our knowledge, this is the first case report for A. naeslundii as part of multimicrobial bacteremia leading to endocarditis, discitis, and osteomyelitis.

Mimics of Crohn's Disease

Crohn's disease is a chronic inflammatory disease that can affect any portion of the gastrointestinal tract. Associated symptoms can vary based on the severity of disease, extent of involvement, presence of extraintestinal manifestations, and development of complications. Diagnosis is based on a constellation of findings. Many diseases can mimic Crohn's disease and lead to diagnostic conundrums. These include entities associated with the gastrointestinal luminal tract, vascular disease, autoimmune processes, various infections, malignancies and complications, drug- or treatment-induced conditions, and genetic diseases. Careful consideration of possible causes is necessary to establish the correct diagnosis.

Abdominopelvic Actinomycosis—The Diagnostic and Therapeutic Challenge of the Most Misdiagnosed Disease

Abdominopelvic actinomycosis is a rare chronic or subacute bacterial infection caused by Actinomyces israelii, a Gram-positive anaerobic bacterium that normally colonizes the digestive and genital tracts, clinically presented as an inflammatory mass or abscess formation. Methods: We reviewed the medical records of the patients from our clinic with abdominopelvic actinomycosis who underwent surgery between 2002 and 2022. In this period, 28 cases (9 men and 19 women) were treated. The mean age was 43.36 years and they were hospitalized for abdominopelvic tumors or inflammatory tumors in 15 cases and inflammatory disease in 13 cases. Results: Causes of actinomycosis in the studied group were an intra-uterine contraceptive device in 17 cases, foreign bodies in 2 cases, diabetes in 4 cases, stenting of the bile duct in 1 case, and immunodepression. For 6 patients, we performed surgery by open approach and for 21 patients by a laparoscopic approach. For nine patients, abdominopelvic actinomycosis had been mimicking a colon malignancy (cecum and ascending colon, four cases; transverse colon, two cases; and on the greater omentum, three cases) and for six patients, a pelvic tumor (advanced ovarian cancer). After surgery the patients underwent specific treatment with antibiotics, with good results. In two cases we discovered and treated hepatic actinomycosis, one case by a laparoscopic approach and one case by a percutaneous approach. In our lot we noticed three recurrences that required reintervention in patients who had had short-term antibiotics due to non-compliance with treatment out of four such cases. Conclusions: For abdominopelvic malignancies, actinomycosis should be included in the differential diagnosis, as well as for inflammatory bowel diseases and bowel obstructions. We have a wide range of patients considering the rarity of this condition. Long-term antibiotics are necessary to prevent recurrence.

Actinomyces causing a brain abscess

Actinomycosis is an uncommon, chronic granulomatous disease caused by the filamentous, gram-positive bacterium Actinomyces israelii. It causes indolent, painful wound infections commonly presenting with oral-cervicofacial manifestations, but other infections of the chest wall and gastrointestinal and genital tract are also seen. A high level of suspicion is required for diagnosis, as it may be missed or mistaken for malignancy. Severe cases may involve the central nervous system and require surgical intervention. We present a case report of actinomycosis causing a brain abscess.

Actinomycosis: a case report of two patients treated for the condition who required stoma formation

Actinomycosis is a rare bacterial condition that is seen infrequently and no studies have examined its prevalence or incidence globally. The author, a stoma care clinical nurse specialist (CNS), found herself caring for two such patients 3 weeks apart, both of whom were diagnosed with pelvic actinomycosis. Both patients had been fitted with copper intrauterine devices (IUDs) 10 years previously and were not aware that leaving IUDs in situ for a prolonged period increased their risk of infection. This article gives an overview of the condition, with discussion around the two patients the author cared for within her own specialty; not all aspects of the condition are included as the she has no clinical experience in microbiology and is not a gynaecological CNS. The case studies show how both women presented and were treated, with interventions including emergency surgery, long-term antibiotic therapy and stoma formation. Pelvic actinomycosis is often associated with the use of an IUD, and greater awareness about the risk of leaving IUDs in situ for prolonged periods is needed among gastrointestinal, colorectal and gynaecological practitioners.

Case report: actinomycosis of the abdominal wall

Primary abdominal wall actinomycosis is rare, but even rarer when it comes to intestinal infiltration; it is usually misdiagnosed as a neoplasm in computed tomography till proved otherwise with pathological examination. We report a 59-year-old diabetic male presented with a year-old abdominal wall mass, diagnosed by pathology after surgical excisional biopsy, and treated with penicillin for 6 months. We recommend consideration of actinomycosis in cases of abdominal wall mass, especially in immunocompromised patients, as a differential diagnosis of neoplastic lesions.

Abdominal actinomycosis mimicking a transverse colon malignancy: a case report and review of the literature

Background

Actinomycosis is a rare inflammatory bacterial disease caused by Actinomyces species which can infrequently affect the large intestine. Disseminated actinomycosis is reported as a rare complication associated with intrauterine devices. We report a case of intra-abdominal actinomycosis mimicking a transverse colon malignancy.

Case presentation

A previously healthy 40-year-old Sinhalese woman was evaluated for intermittent colicky left-sided abdominal pain for 2 months’ duration. Computed tomography of the abdomen showed a circumferential thickening of the wall and narrowing of the lumen of the descending colon with evidence of extraluminal extension to the adjacent parietal peritoneum and abdominal wall suggestive of a stage IV neoplasm. An exploratory laparotomy with extended left hemicolectomy was performed. Macroscopic evaluation revealed a mass lesion with multiple abscesses attached to the transverse and descending colon. Histology was suggestive of actinomycosis with no evidence of malignancy.

Conclusions

Abdominal actinomycosis should be considered in a young patient with chronic abdominal pain. It should be understood that the presentation may be vague and highly variable. Computed tomography-guided biopsy/fine needle aspiration or laparoscopy and biopsy may be useful in arriving at a diagnosis and can prevent unnecessary surgical intervention.

Hepatobiliary Actinomycosis, a Rare Presentation of a Rare Disease!

Actinomycosis is a chronic granulomatous infection caused by opportunistic bacteria, Actinomyces. These bacteria lack virulence and cause disease when there is a breach in the integrity of the mucosa. Diagnosis of Actinomycosis is challenging and less than 10% of abdominopelvic cases are diagnosed preoperatively. The treatment involves prolonged course of antibiotics with or without removal of tissue. In this case report we will present a case of hepatobiliary actinomycosis which was managed by a combination of both surgical and medical treatment.

Pelvic actinomycosis: a forgotten cause of pelvic pain

Actinomycosis is an invasive and suppurative anaerobic infection, which can develop in the pelvis. This occurs most commonly as a result of prolonged use of an intrauterine device. The constellation of signs and symptoms associated with its typical clinical presentation include palpable mass, weight loss and malaise. It can be misdiagnosed as a result and often as a malignant process. Left unrecognised, pelvic actinomycosis can lead to sequelae such as severe abscess, fistula formation and even infertility. Removal of the intrauterine device and a prolonged course (6-12 months) of antibiotic treatment form the cornerstone of management. Surgery can be required in select cases. This article provides an overview of pelvic actinomycosis, including its background, presentation, investigations and management.

Appendiceal actinomycosis mimicking appendiceal tumor, appendicitis or inflammatory bowel disease

Appendiceal actinomycosis is very rare and its diagnosis is often difficult even in surgically resected specimens. Here we report two cases of appendiceal actinomycosis confirmed by pathologic examination of surgically resected specimens. Characteristic histologic features included transmural chronic inflammation with Crohn-like lymphoid aggregates and polypoid mucosal protrusion into cecal lumen through fibrous expansion of the submucosa. Chronic active inflammation involved the mucosa of the appendix and cecum around the appendiceal orifice. Crohn’s disease with predominant cecal involvement and inflammatory pseudotumor were considered as differential diagnoses. Careful examination revealed a few actinomycotic colonies in the mucosa, confirming the diagnosis. A high index of suspicion with awareness of the characteristic histologic features might prompt careful inspection for the actinomycotic colonies, leading to the appropriate diagnosis of this rare disease.

Abdominal actinomycosis misconceived as intestinal lymphoma: Report of a case

INTRODUCTION

Abdominal actinomycosis is a rare clinical entity and it is difficult to make the correct preoperative diagnosis because of its nonspecific clinical symptoms and varied radiological findings. The diagnosis is usually made after the patient undergoes an operation and tissue is available for pathological evaluation. When the diagnosis is made, the patient should be treated with the appropriate long-term antibiotics.

PRESENTATION OF CASE

A 69-year-old male patient was transferred to our hospital complaining of a palpable mass, painful abdominal discomfort, weight loss, and night sweating. After colonoscopy and radiologic studies, our presumptive diagnosis was intestinal lymphoma combined with ileocecal intussusception. He was found to have abdominal actinomycosis after surgery and successfully treated with ampicillin for six months.

DISCUSSION

Pre-operative radiological imaging in abdominal actinomycosis is unlikely to allow a definitive diagnosis, but CT scanning is the single most useful imaging modality. Although we performed preoperative radiological studies, including CT, none led to a diagnosis of abdominal actinomycosis, we mistakenly considered the case as intestinal lymphoma combined with ileocecal intussusception.

CONCLUSION

Physicians should include abdominal actinomycosis in the differential diagnosis when an abdominal mass presents an irregular, infiltrative growth pattern, even though ileocecal intussusception is an extremely rare presentation in abdominal actinomycosis.

Differential diagnosis of inflammatory bowel disease: imitations and complications

Inflammatory bowel disease (IBD) is characterised by episodes of relapse and periods of remission. However, the clinical features, such as abdominal pain, diarrhoea, and rectal bleeding, are not specific. Therefore, the differential diagnosis can include a broad spectrum of inflammatory or infectious diseases that mimic IBD, as well as others that might complicate existing IBD. In this Review, we provide an overview of ileocolitis of diverse causes that are relevant in the differential diagnosis of IBD. We highlight the importance of accurate patient profiling and give a practical approach to identifying factors that should trigger the search for a specific cause of intestinal inflammation. Mimics of IBD include not only infectious causes of colitis-and particular attention is required for patients from endemic areas of tuberculosis-but also vascular diseases, diversion colitis, diverticula or radiation-related injuries, drug-induced inflammation, and monogenic diseases in very-early-onset refractory disease. A superinfection with cytomegalovirus or Clostridium difficile can aggravate intestinal inflammation in IBD, especially in patients who are immunocompromised. Special consideration should be made to the differential diagnosis of perianal disease.

Severe abdominopelvic actinomycosis with colon perforation and hepatic involvement mimicking advanced sigmoid colon cancer with hepatic metastasis: a case study

BACKGROUND

Actinomycosis is a rare chronic invasive disease caused by Actinomyces spp. Although abdominopelvic actinomycosis, which involves the colon and the pelvic organs extensively, has been frequently reported, abdominopelvic actinomycosis presenting with colon perforation and hepatic involvement concurrently has yet to be reported.

CASE PRESENTATION

A 55-year-old woman presented at the emergency room with squeezing epigastric pain. Palpation of the abdomen revealed a hard mass with no acute peritoneal signs. Vital signs were normal range except for tachycardia. Initial laboratory testing revealed leukocytosis, anemia, elevated C-reactive protein (CRP), hypoalbuminemia; and normal AST/ALT and BUN/creatinine. CT scan of the abdomen-pelvis revealed a microperforations of the sigmoid colon, abscess in the left lower quadrant and hepatic lesion. Furthermore, there was a large infiltrating conglomerated mass invading the urinary bladder, left adnexa, sigmoid, left inguinal canal and left pelvic wall area. Ultrasound revealed an intra-uterine device (IUD). All these findings initially raised a suspicion of malignancy such as advanced cancer of the colon with liver metastasis. Despite the rarity of the disease, actinomycosis were not excluded because of the IUD found on ultrasound. Parenteral antibiotics and percutaneous drainage of abdomen abscess as well as fasting with total parental nutrition were prescribed for sigmoid perforation and abscess. After 10 days of conservative treatment, no remarkable change was detected in conglomerated mass invading pelvis. Furthermore, the finding of newly developed mechanical small bowel obstruction warranted surgery. Exploratory laparotomy was performed for the removal of perforated colon, obstructive small bowel and organs involved and postoperative histology confirmed a diagnosis of colonic actinomycosis. The patient made an uneventful recovery and was started on a 6-month course of penicillin.

CONCLUSIONS

Abdominopelvic actinomycosis presenting with colon perforation and hepatic involvement is extremely rare; however, it is clinically similar to advanced colon cancer with liver metastasis, therefore, complicating the preoperative diagnosis. A diagnosis of abdominopelvic actinomycosis should be considered in patients with a history of IUD and chronic abdominal pain, along with an abdominal mass or cutaneous abscess. If surgery is indicated, preoperative empirical antibiotic therapy for actinomycosis and frozen biopsy during surgery may be considered.

A Rare Thermophilic Bug in Complicated Diverticular Abscess

Actinomycosis is a form of painful abscess in the gastrointestinal tract or in deep tissue caused by actinomyces species. They are one of the commensal bacteria in the oral cavity and gastrointestinal tract of humans but can opportunistically cause infection in immunosuppressive hosts through invasion of breached mucosa or necrotic tissue while mimicking malignancy, gastrointestinal tuberculosis, and inflammatory bowel disease. Actinomyces israelii is, by far, the major and most common human pathogen throughout literatures. By virtue of rarity and diagnostic confusion with masquerading malignancies, only 10% of the cases have been diagnosed preoperatively, so as to be able to verge patients from undergoing unnecessary surgical intervention. Herein, we present a rare case of complicated diverticular abscess manifested by Actinomyces meyeri after postoperative tissue diagnosis.

Colonic obstruction secondary to Actinomyces

Actinomycosis is an uncommon granulomatous infection by Gram-positive anaerobic bacteria of the genus Actinomyces. A. israelii is a major human pathogen. The most frequent locations for colonization are cervicofacial (50%), abdominal (20%) and thoracic (15-20%). The abdominal actinomycosis predisposing factors include recent surgery, trauma and neoplasias. Certain cases have been associated with the intrauterine contraception device (IUD).

[Actinomycosis Involving Chronic Pancreatitis: A Case Report with Literature Review]

Actinomycosis is a slowly progressive, chronic infectious disease. It is caused by the genus Actinomyces, which are gram-positive anaerobic bacteria. It presents as a mass-like lesion, composed of bacterial nidus and characteristic granulomatous inflammatory fibrosis. As such, it has frequently been mistaken for a malignancy. Surgical resection is a common procedure in these patients prior to a definite diagnosis. Although actinomycosis can occur in a variety of regions, including oral-cervicofacial, thoracic, and abdominopelvic cavities, the involvement of the pancreas is very rare. We report a case of a 44-year-old male with a symptomatic actinomycosis caused by a mass in the tail of the pancreas. The diagnosis was made using an endoscopic ultrasound-guided fine needle aspiration biopsy without surgical resection. After the treatment with antibiotics, the pancreatic mass was confirmed to be resolved on the follow-up computed tomography.

A rare case of primary urachal actinomycosis mimicking malignancy

Primary actinomycosis occurring in urachal remnants is rarely documented in literature and may mislead the clinicians to diagnose urachal carcinoma. A 50-year-old man came with complaints of lower abdominal pain, dysuria, and dribbling of urine for 2 months. A vague mass of 7 cm was palpable in the suprapubic region. Imaging of the abdomen revealed an irregular mass seen superior to fundus of the urinary bladder appearing adherent to mesentery and bowel loops, suggesting an urachal remnant associated lesion with infiltration. Provisional diagnosis of urachal carcinoma was considered. Excision of the mass with partial cystectomy and resection of involved ileal segments were done. Microscopic examination revealed actinomycotic colonies surrounded by microabscesses and dense inflammatory fibrotic lesion. Small intestinal segments showed a similar lesion in the serosa.

Abdominal actinomycosis in the last 10 years and risk factors for appendiceal actinomycosis: review of the literature

BACKGROUND/AIM

Actinomycosis is a granulomatous disease caused by filamentous, gram-positive, anaerobic bacteria. Actinomycetes are commensal inhabitants of the oral cavity and intestinal tract but acquire pathogenicity through invasion of breached or necrotic tissue.1397645907In abdominal actinomycosis (AA), the appendix and ileocecal region are usually involved. The aim of this study was to characterize patients diagnosed with AA and to establish the risk factors for appendiceal actinomycosis, including a short review of the literature.

MATERIALS AND METHODS

We conducted a prospective cohort study of all patients diagnosed with AA in the University Hospital Marques de Valdecilla (Santander-Cantabria) from January 2003 to October 2013. We also conducted a short review of the literature.

RESULTS

We characterized the epidemiological features of patients diagnosed with AA and risk factors for the involvement of the appendix, as most of the cases were misdiagnosed as appendicitis. Risk factors for appendiceal actinomycosis are no antecedents of carcinoma (P = 0.034) and previous incorrect diagnosis (P = 0.006).

CONCLUSION

AA is a rare and chronic infection. It is only reported in case reports in the literature. We present the largest series of patients diagnosed with AA. Half of the patients had morbidities, mostly carcinoma, and penicillin was the preferred treatment. More studies are needed to characterize patients affected with AA and to establish the correct treatment.

Clinical features of actinomycosis: A retrospective, multicenter study of 28 cases of miscellaneous presentations

Actinomycosis is a rare heterogeneous anaerobic infection with misleading clinical presentations that delay diagnosis. A significant number of misdiagnosed cases have been reported in specific localizations, but studies including various forms of actinomycosis have rarely been published.We performed a multicenter retrospective chart review of laboratory-confirmed actinomycosis cases from January 2000 until January 2014. We described clinical characteristics, diagnostic procedures, differential diagnosis, and management of actinomycosis of clinical significance.Twenty-eight patients were included from 6 hospitals in France. Disease was diagnosed predominately in the abdomen/pelvis (n = 9), orocervicofacial (n = 5), cardiothoracic (n = 5), skeletal (n = 3), hematogenous (n = 3), soft tissue (n = 2), and intracranially (n = 1). Four patients (14%) were immunocompromised. In most cases (92 %), the diagnosis of actinomycosis was not suspected on admission, as clinical features were not specific. Diagnosis was obtained from either microbiology (50%, n = 14) or histopathology (42%, n = 12), or from both methods (7%, n = 2). Surgical biopsy was needed for definite diagnosis in 71% of cases (n = 20). Coinfection was found in 13 patients (46%), among which 3 patients were diagnosed from histologic criteria only. Two-thirds of patients were treated with amoxicillin. Median duration of antibiotics was 120 days (interquartile range 60-180), whereas the median follow-up time was 12 months (interquartile range 5.25-18). Two patients died.This study highlights the distinct and miscellaneous patterns of actinomycosis to prompt accurate diagnosis and earlier treatments, thus improving the outcome. Surgical biopsy should be performed when possible while raising histologist's and microbiologist's awareness of possible actinomycosis to enhance the chance of diagnosis and use specific molecular methods.

Cytopathology of Hepatobiliary-Related Actinomycosis

BACKGROUND

The clinical diagnosis of hepatobiliary-related actinomycosis can be challenging owing to its rarity and variable presentation. Moreover, actinomycotic pseudotumors may mimic malignancy and result in unnecessary surgical resection. Herein, we present the clinical and cytopathological features of 3 cases with hepatobiliary-related actinomycosis.

CASES

The first patient was a 73-year-old man who presented with an exophytic liver lesion. The second patient was a 78-year-old woman who presented with a biliary stricture. The third patient was an 88-year-old woman with a right flank mass extending to the liver. The aspirate smears in these 3 cases demonstrated 'cotton ball' clusters of filamentous microorganisms and abscesses. The cell blocks of 2 of the patients showed sulfur granules with peripheral filamentous microorganisms positive with a Gram stain but negative with an acid fast stain, consistent with Actinomyces species. All patients were elderly and shared a past surgical history of laparoscopic cholecystectomy.

CONCLUSION

These cases demonstrate the complementary role of cytology in the diagnosis of hepatobiliary actinomycosis. A cytologic diagnosis of actinomycosis is minimally invasive and quick. It can prompt proper culture medium selection and avoid unnecessary or extensive surgery. Based on our experience, laparoscopic cholecystectomy may be a precipitating factor for the subsequent development of hepatobiliary-related actinomycosis.

[Acute abdomen with actinomycosis of the colon: A case report]

BACKGROUND

Actinomyces infection is a chronic inflammatory process that can sometimes, clinically and radiographically, closely mimic a malignant tumour, which may lead to giving a delayed or inappropriate treatment.

CLINICAL CASE

Male 41 years old, with no previous history, with abdominal pain of one month onset, as well as weight loss, intermittent fever and diarrhoea. He developed acute abdomen and underwent surgery, finding a tumour in the distal ileum with necrosis and punctiform perforations. A resection was performed on the affected part of the ileum and colon, as well as an ileostomy using Hartmann's procedure.

CONCLUSIONS

Actinomycosis is a disease that must be considered by the surgeon when faced with a clinical picture of subacute onset with intermittent fever, weight loss, abdominal pain, and even anaemia in patients with abdominal and retroperitoneal abscesses or previous history of surgery.

Abdominal actinomycosis after laparoscopic cholecystectomy: an uncommon presentation of an uncommon problem

Actinomycosis is a rare bacterial infection with a broad clinical presentation that is seldom reported after elective cholecystectomy. We present an as-of-yet unreported case of actinomycosis in an 81-year-old gentleman who was found to have right-sided peritonitis and small bowel obstruction 11 months after elective laparoscopic cholecystectomy. A complex loculated lesion was found on laparotomy with a protracted course of antibiotics being needed for treatment. The rarity of this condition will mean it remains a surprise diagnosis to many clinicians. However, it is important that clinicians maintain some index of suspicion to prevent unnecessary surgery and are aware of the protracted course of antibiotics that is needed for successful treatment.

Liver involvement in systemic infection

The liver is often involved in systemic infections, resulting in various types of abnormal liver function test results. In particular, hyperbilirubinemia in the range of 2-10 mg/dL is often seen in patients with sepsis, and several mechanisms for this phenomenon have been proposed. In this review, we summarize how the liver is involved in various systemic infections that are not considered to be primarily hepatotropic. In most patients with systemic infections, treatment for the invading microbes is enough to normalize the liver function tests. However, some patients may show severe liver injury or fulminant hepatic failure, requiring intensive treatment of the liver.

Abdominopelvic actinomycosis: spectrum of imaging findings and common mimickers

BACKGROUND

Actinomycosis is a rare suppurative disease that may mimic other inflammatory conditions on imaging. Its invasive nature may lead to mass formation and atypical presentation thus making accurate diagnosis quite difficult.

PURPOSE

To describe the different aspects of abdominopelvic actinomycosis on cross-sectional imaging and indicate discriminative findings from other inflammatory or neoplastic diseases.

MATERIAL AND METHODS

In our study we analyzed 18 patients (15 women, 3 men; age range, 25-75 years; mean age, 50 years) with pathologically proved abdominopelvic actinomycosis. Contrast-enhanced abdominal computed tomography (CT) had been performed in all patients. Eleven patients had a history of using intrauterine contraceptive devices. Bowel site, wall thickness and enhancement degree, inflammatory infiltration, and features of peritoneal or pelvic mass were evaluated at CT.

RESULTS

The sigmoid colon was most commonly involved. Most patients showed concentric bowel wall-thickening, enhancing homogenously and inflammatory infiltration of pericolonic fat was mostly diffuse. In 11 patients, one or more pelvic abscesses were revealed, while a peritoneal or pelvic mass adjacent to the involved bowel segment was seen in three cases. Infiltration into the abdominal wall was seen in three cases while in one case there was thoracic dissemination.

CONCLUSION

Actinomycosis is related not only to long-term use of intrauterine contraceptive devices and should be included in the differential diagnosis when cross-sectional imaging studies show concentric bowel wall-thickening, intense contrast enhancement, regional pelvic or peritoneal masses, and extensive inflammatory fat infiltration with abscess formation.

Primary urachal actinomycosis: case report and literature review

Actinomycosis can involve all parts of the urogenital system. Urachal actinomycosis rarely reported and was mistaken with urachal adenocarcinoma. We report a case of urachal actinomycosis that presented with abdominal pain and underwent laparotomy with the diagnosis of urachal malignancy pathology reviewed the diagnosis of urachal actinomycosis. Patient had no problem in two years follow up.

Abdominal actinomycosis masquerading as an omental tumor in a 12-year-old female

We herein report a case of abdominal actinomycosis in a 12-year-old girl in whom an omental primary tumor was suspected before surgery. The patient began to experience intermittent lower left abdominal pain. Abdominal computed tomography (CT) scans were inconclusive at this time, but 6 months later, CT and magnetic resonance imaging (MRI) examinations showed a 7-cm, tumor-like lesion in the left abdominal cavity; malignancy could not be ruled out. The tumor, which originated in the omentum and adhered strongly to the left abdominal wall, was resected along with approximately 90 % of the omentum, the peritoneum in contact with the mass, and the posterior layer of the rectus abdominal sheath, under suspicion of a malignant tumor. However, omental actinomycosis was the final pathological diagnosis. The patient's antibiotic treatment was changed to a penicillin-series oral antibiotic to prevent recurrence of the actinomycosis. The patient was discharged from our hospital 16 days after the first surgery, but she developed three episodes of ileus; the first two required surgery. The patient has had no further recurrences of actinomycosis or postoperative ileus 20 months after discharge.

Abdominal Actinomycosis-an Interesting Case

Actinomyces are part of normal oral flora and cause disease only when the normal mucosal barrier is breached. Reported annual incidence of actinomycosis is 1 case per 300,000 persons (Weese and Smith, Arch Intern Med 135:1562-1568, 1975). Preoperative diagnosis of abdominal actinomycosis is difficult. An accurate diagnosis is always obtained by histological examination and often requires surgical resection. This case of mesenteric panniculitis due to fish bone penetrating the gut wall and lodging in the omentum has been taken for its rare presentation.

Appendicitis: When there is more than meets the eye

Acute appendicitis is the most frequent emergency in gastrointestinal surgery. Obstruction of the appendiceal lumen appears to be one of the most common physiologic mechanisms for the development of acute appendicitis. Once obstructed, the dilatation of the lumen causes ischemia and necrosis of the wall. The most common organisms involved in appendicitis are Escherichia coli, Peptostreptococcus, Bacillus fragilis and Pseudomonas. Rarely, Actinomyces is involved in this process. In this case report, we report a case of actinomycosis of the appendix vermiformis occurring in a 19-year-old male with no predisposing factors. Along with a review of the literature, we will define the risk factors, clinical characteristics, diagnostic methods, and treatment of actinomycosis.

Laparoscopic resection of omental actinomycosis forming fistula with transverse colon and jejunum: a case report and review of literature

Omental actinomycosis without any predisposing factors is rare, and there are few reports on it invading the contiguous bowels to form fistulae. We describe the case of a 55-year-old male patient with omental actinomycosis that presented as an inflammatory tumor that formed fistulae with the transverse colon and upper jejunum. On admission, he had complaints of a palpable, tender mass on the left mid-abdomen without gastrointestinal symptoms. After 7 days of conservative treatments (NPO and intravenous antibiotics), the size of the mass was decreased and tenderness was more improved. Laparoscopic resected omental mass revealed fistulae to the colon and jejunum. There was no evidence of Crohn disease. After 1-week use of antibiotics owing to the concern about actinomycosis, the mass was decreased and it was more amenable to dissect laparoscopically.

Clinical features of abdominal actinomycosis: a 15-year experience of a single institute

This study was designed to evaluate the clinical features of abdominal actinomycosis and to assess its therapeutic outcome. We reviewed patients with abdominal actinomycosis in Seoul St. Mary hospital, between January 1994 and January 2010. Twenty-three patients (5 male and 18 female, mean age, 47.8 yr; range, 6-75 yr), with abdominal actinomycosis were included. Emergency surgery was performed in 50% due to symptoms of peritonitis. The common presentation on preoperative computerized tomography was a mass with abscess, mimicking malignancy. The mean tumor size was 7.0 cm (range, 2.5-10.5). In all patients, actinomycotic masses were surgically removed. Mean duration of hospital stay was 17.8 days (range, 5-49). Long term oral antibiotic treatment (mean 4.2 months; range, 0.5-7.0 months) were administered to all patients. All patients were free of recurrence after a median follow up of 30.0 months (mean 35.5 ± 14.8 months, range, 10.0-70.0 months); recurrence was not seen in any patient. In conclusion, abdominal actinomycosis should be included as a differential diagnosis when an unusual abdominal mass or abscess presents on abdominal CT. Assertive removal of necrotic tissue with surgical drainage and long term antibiotic treatment provide a good prognosis in patients with actinomycosis.

Modern management of pyogenic hepatic abscess: a case series and review of the literature

Background

Pyogenic hepatic abscesses are relatively rare, though untreated are uniformly fatal. A recent paradigm shift in the management of liver abscesses, facilitated by advances in diagnostic and interventional radiology, has decreased mortality rates. The aim of this study was to review our experience in managing pyogenic liver abscess, review the literature in this field, and propose guidelines to aid in the current management of this complex disease.

Methods

Demographic and clinical details of all patients admitted to a single institution with liver abscess over a 5 year period were reviewed. Clinical presentation, aetiology, diagnostic work-up, treatment, morbidity and mortality data were collated.

Results

Over a 5 year period 11 patients presented to a single institution with pyogenic hepatic abscess (55% males, mean age 60.3 years). Common clinical features at presentation were non-specific constitutional symptoms and signs. Aetiology was predominantly gallstones (45%) or diverticular disease (27%). In addition to empiric antimicrobial therapy, all patients underwent radiologically guided percutaneous drainage of the liver abscess at diagnosis and only 2 patients required surgical intervention, including one 16-year old female who underwent hemi-hepatectomy for a complex and rare Actinomycotic abscess. There were no mortalities after minimum follow-up of one year.

Conclusions

Pyogenic liver abscesses are uncommon, and mortality has decreased over the last two decades. Antimicrobial therapy and radiological intervention form the mainstay of modern treatment. Surgical intervention should be considered for patients with large, complex, septated or multiple abscesses, underlying disease or in whom percutaneous drainage has failed.