Perianal actinomycosis—A complication of a fistula-in-ano

R, Alvarado-Cerna; Bracho-Riquelme, Rodolfo Leonel

doi:10.1007/bf02053601

Cited by 32 publications

(24 citation statements)

References 6 publications

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“…[23][24][25] Primary anorectal and perianal actinomycosis are very rare. [14][15][16][17][18][19][20][21][22][26][27][28][29] According to Cope, 26 infection with Actinomyces species occurs so seldom in the colon and the anorectum that no surgeon, even a proctologist, is likely to see more than a few cases in a lifetime.…”

Section: Discussionmentioning

confidence: 99%

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Actinomycosis, A Rare and Unsuspected Cause of Anal Fistulous Abscess: Report of Three Cases and Review of the Literature

Coremans¹,

Margaritis²,

Poppel³

et al. 2005

Diseases of the Colon &Amp; Rectum

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Primary perianal actinomycosis is rare. Sporadic cases, with lesions varying in extent have been reported. The infection is caused by the bacterium Actinomyces, which often is a saprophyte. Male gender and diabetes are risk factors, but the exact pathogenic mechanism remains speculative. The diagnosis is a challenge and often delayed, with a protracted history of masses and sinuses extending into the gluteal and genital region. The treatment, a combination of surgery and antibiotics, is poorly standardized. We report three cases and compare their characteristics to those of published cases, found by a computerized literature search (1968-2002). The lesions, a simple fistula-in-ano or a mass, were diagnosed in an early stage in all three patients. The infection always spread into the scrotum. There were no risk factors other than gender, except in one patient. The diagnosis was suspected by the observation of draining sulfur granules and promptly confirmed by histology in the three cases. All patients healed with antibiotics in addition to simple surgical procedures. Treatment consisted of amoxicillin for two weeks in two cases and more extended antimicrobial treatment in the third. These findings are contrasting with the classic picture of perianal actinomycosis. It is concluded that perianal actinomycosis can occur in the absence of risk factors and that early diagnosis requires a high degree of suspicion. An infection with Actinomyces should be suspected in the presence of lesions containing watery purulent material with sulfur granules. The indication for extended antibiotherapy combined with sphincter damaging surgery may need to be revised in the presence of early detection.

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Section: Discussionmentioning

confidence: 99%

“…23 The male predominance in perianal actinomycosis also is striking, an observation consistent with our findings. [14][15][16][17][18][19][20][21][22] The pathophysiology of actinomycosis remains partially unexplained. In humans, Actinomyces israelii colonizes the mouth, oropharynx, and vagina.…”

Section: Discussionmentioning

confidence: 99%

Actinomycosis, A Rare and Unsuspected Cause of Anal Fistulous Abscess: Report of Three Cases and Review of the Literature

Coremans¹,

Margaritis²,

Poppel³

et al. 2005

Diseases of the Colon &Amp; Rectum

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“…Morson [11]first described this condition in 1961, and suggested that all rectal strictures should be biopsied for exclusion of this infection. Primary rectal actinomycosis in association with perirectal abscesses and perianal fistulae has been reported [12, 13]. Until 1986, two additional cases of pelvic actinomycosis presenting with rectal stricture were reported [14, 15].…”

Section: Discussionmentioning

confidence: 99%

Pelvic Actinomycosis Presenting as Ureteric and Rectal Stricture

Haj¹,

Nasser²,

Loberant³

et al. 2000

Dig Surg

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Background/Aims: Simultaneous ureteric and rectal stricture due to pelvic actinomycosis is very rare and only a few cases of either rectal or ureteric stricture have been reported. Our aim is to report a case of stricture of the rectum and the right ureter due to pelvic actinomycosis infection in a 63-year-old man. Methods: Explorative laparotomy and biopsies of the inflammatory pelvic mass were the only procedures that led to the definitive diagnosis of actinomycosis. Temporary diverting colostomy, drainage of the right ureter by a pigtail catheter and postoperative treatment with appropriate antibiotics were successful in eradicating the inflammatory process. Conclusions: Extensive pelvic masses involving pelvic viscera should be biopsied before undertaking any major surgery because of the possibility of pelvic actinomycosis.

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“…Hydronephrosis due to extrinsic compression of the actinomycotic granuloma has also been reported [6,7,11]. Anorectal and hepatobiliary primary actinomycosis have already been described in the literature (16)(17)(18). The involvement of multiple organs, such as in this patient, is rare but has been previously reported [6,7,19].…”

Section: Discussionmentioning

confidence: 67%