Abdominal-Pelvic Actinomycosis Mimicking Malignant Neoplasm

Abstract

Abdominal-pelvic actinomycosis is often mistaken for other conditions, presenting a preoperative diagnostic challenge. In a 46-year-old female, computed tomography showed an abdominal-pelvic retroperitoneal mass extending from the lower pole of the right kidney to the lower pelvis. The patient had a 3-year history of intrauterine device. The mass appeared to involve the ascending colon, cecum, distal ileum, right Fallopian tube and ovary, and ureter anteriorly and the psoas muscle posteriorly. The resection of retroperitoneal mass, distal ileum appendicectomy, right hemicolectomy, and right salpingo-oophorectomy was performed. The postoperative period was uneventful. Penicillin therapy was given for six months without any complication. The retroperitoneal mass measured 4.5 × 3.5 × 3 cm, surrounded adjacent organs and histologically showed inflammatory granulomatous tissue, agglomeration of filaments, and sulfur granules of Actinomyces, with positive reaction with periodic acid Schiff. Right tubo-ovarian abscess was present. Abdominalpelvic actinomycosis should always be considered in patients with a pelvic mass especially in ones using intrauterine device.

Case 219: Pelvic Actinomycosis Mimicking Malignant Tumor

“…Actinomycosis is a rare chronic suppurative granulomatous infection that occurs when the mucosal barrier is broken. About 80% of cases of pelvic actinomycosis involve women who are using an IUD (10). In 25% of women, IUDs eventually become infected by Actinomyces, and 2%-4% of women with colonized IUDs ultimately develop serious actinomycotic infections (1).…”

Mesenteric tumors: Diagnosis and treatment

“…The microorganism is not ordinarily pathogenic in immunocompetent patients, however a mucosal breach due to trauma, foreign body, surgery, intestinal perforation, or inflammatory bowel disease may predispose to infection. The presence of an IUD is a risk factor [37]. Infections occur in cervicofacial (> 50%), thoracic (20%) and abdominopelvic (20%) locations.…”

Can Surgery Be Avoided? Exclusive Antibiotic Treatment for Pelvic Actinomycosis

“…The infection is characterized by suppurative and granulomatous inflammation, contiguous spread, and the formation of colonies described macroscopically as sulfur granules [2, 3, 6]. It can become pathogenic when mucosal integrity is compromised or in the presence of a foreign body, like an IUD [2].…”