Intrauterine contraceptive device‐related actinomycosis infection presenting as an incarcerated inguinal hernia

Abstract

We report an unusual case of an intrauterine contraceptive device (IUCD)-related pelvic actinomyces infection presenting as an incarcerated inguinal hernia. An emergency laparotomy showed the presence of pyometra with large abscesses, involving both fallopian tubes and the right ovary with pyometra tracking down the left psoas into the groin, giving a clinical and radiological appearance of an incarcerated hernia. Subsequent results obtained from investigations showed the presence of actinomyces-like organisms on the patient's smear related to an IUCD.

<i>Actinomyces turicensis</i> Bacteremia Secondary to Pyometra

“…Although Actinomyces has been reported to be the causative pathogen of pyometra, almost all such described cases were associated with the use of an IUD (10). Because of its low virulence, Actinomyces cannot invade organs without any underlying damage to the mucous membranes or tissues.…”

Differentiating pelvic actinomycosis from advanced ovarian cancer: a report of two cases, management reflections and literature review

“…Several case reports of pelvic actinomycosis mimicking ovarian malignancies have been published [ 3 , 25 – 27 ] and (Table 1 ). Pelvic actinomycosis has been known to present as a rectal mass with hydronephrosis [ 28 ], following hysteroscopic removal of IUD [ 29 ] or incarcerated inguinal hernia [ 30 ]. In the presence of an abdominopelvic mass with suspected deposits, laparoscopy was a less invasive approach of establishing a definitive diagnosis, thereby minimising the risk for mutilating surgery.…”

Successful outpatient management of pelvic actinomycosis by ceftriaxone: a report of three cases

“…Though frequently cited [6], the association between IUCD use and development of pelvic actinomycosis is a controversial one. It is accepted that the risk of pelvic actinomycosis resulting from IUCD use is very low.…”