Ureteric Obstruction Secondary to Pelvic Actinomycosis

Jackson, AE; Parry, J.R.W.; Shah, P.J.R.

doi:10.1111/j.1464-410x.1988.tb04275.x

Cited by 14 publications

(5 citation statements)

References 7 publications

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“…Brown responded well to tetracycline therapy alone (25). Another 45-year old female, with IUD use for more than 13 years, presented with bilateral ureteric obstruction secondary to a large pelvic mass involving the uterus, tubes, ovaries, and rectum (26). Fulton et al reported 2 cases with ureteric obstruction, secondary to IUD-associated Pelvic actinomycosis (27).…”

Section: Discussionmentioning

confidence: 99%

Pelvic actinomycosis: urologic perspective

et al. 2004

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Section: Discussionmentioning

confidence: 99%

Pelvic actinomycosis: urologic perspective

et al. 2004

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“…The inflammation can result in a frozen pelvis, making surgery treacherous with ill‐defined tissue planes and distorted anatomy. Ureteric obstruction due to the inflammatory mass leading to hydronephrosis has been well described 9 . Thus the efficacy of conservative treatment with antibiotics is welcomed.…”

Section: Discussionmentioning

confidence: 99%

Psoas abscess: an unusual complication of an intrauterine contraceptive device

Stutz

Wilkinson

1999

BJOG

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A 38 year old woman was admitted as an emergency with acute on chronic lower back pain. Examination revealed a fixed flexion deformity of the left hip, but no neurological deficit. She had lost 11 kg in weight over the preceding two months, and had recently had investigations for iron deficiency anaemia. Endoscopy showed that she had an oesophageal web, but no inflammation or bleeding to account for the anaemia. She was treated with fluconazole for cundidu, which had been identified in the oesophagus and was prescribed ferrous sulphate.Initial investigations revealed a hypochromic microcytic anaemia of 7.2 g &-' and an elevated white cell count of 15.6 x lo9 L-' (neutrophilia). The erythrocyte sedimentation rate was elevated at 94 mm h-' and her Creactive protein 285 mg L-' (normal range 1-10 mg L-'). Serum B12, folate and red cell folate were normal as were urea, electrolytes and CA125. She was negative for human immunodeficiency virus; early morning urine and sputum samples were negative for tuberculosis. Lumbar spine and pelvic radiographs revealed no significant abnormality. On isotope bone scan a right hydronephrosis and hydroureter were seen, although no focus of increased bone scintigraphic activity was apparent. An ultrasound examination revealed not only bilateral hydronephrosis but also an elongated hypoechoic lesion inferior to the left kidney within the retroperitoneum. A psoas collection was suspected and confirmed by computed tomography. A computed tomography guided drainage procedure was undertaken. Thick pus was aspirated and sent for culture. A J-guide wire was passed into the psoas collection. The tract was dilated using 8 and 9 F dilators and an 8.4 F pigtail drain was passed and sutured to the skin.An intravenous urogram examination demonstrated partial obstruction at the lower end of the right ureter. On the left side there was only a faint nephrogram and no contrast was seen in the collecting system 18 hours post injection. A left antegrade pyelogram was performed Culture of the psoas muscle aspirate subsequently grew both Actinomyces sp. and Prevatella bivia. Therapy was commenced with a three month course of metronidazole (500 mg three times daily, intravenously, for five days then 400mg three times daily by mouth) and augmentin (1.2 g three times daily for five days then 625 mg three times daily by mouth) on the advice of the hospital microbiology department. The suspicion that her infection might be related to an intrauterine contraceptive device (IUCD) was raised. She had been using an IUCD as contraception for 10 years and although it had been changed 18 months previously, she had been troubled with a brownish discharge since. The current IUCD was copper, but the nature of the previous IUCD was not determined.A transvaginal ultrasound examination revealed bilateral cystic adnexal masses suggestive of hydro-or pyosalpinx. Curettage, cystoscopy and laparoscopy were performed under general anaesthesia. High vaginal and endocervical swabs were obtained, and a CU375 (multiload) IUCD was re...

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“…The infection has a long latent period with unspecific clinical signs, and is easily confused with a malignant neoplasic process, 9ÿ11 given the capacity of Actinomyces to produce fibrosis in the tissues and to cause intestinal as well as ureteral obstruction. 12 In general, most authors concur that the best treatment for pelvic actinomycosis is the combination of surgery and specific antibiotherapy. 3).…”

Section: Discussionmentioning

confidence: 99%

“…7 In the context of her illness our patient presented compression of the right ureter, an infrequent complication in this type of infection as demonstrated by the scarcity of cases of ureteral obstruction referred to in the relevant literature. 12 In general, most authors concur that the best treatment for pelvic actinomycosis is the combination of surgery and specific antibiotherapy. 13 Actinomyces may be treated with penicillin, being characterized by its positive response to the latter, although some cases of negative response to this antibiotic have been described.…”

Section: Discussionmentioning

confidence: 99%