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Laish I, Benjaminov O, Morgenstern S, Greif F, Ben-Ari Z. Abdominal actinomycosis masquerading as colon cancer in a liver transplant recipient. Transpl Infect Dis 2011; 14:86-90. [PMID: 22093111 DOI: 10.1111/j.1399-3062.2011.00669.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2010] [Revised: 05/01/2011] [Accepted: 06/28/2011] [Indexed: 11/26/2022]
Abstract
Infections in transplant recipients are associated with high morbidity and mortality, making their early recognition and treatment particularly important. Abdominal actinomycosis is a rare clinical entity and difficult to diagnose because of its various and nonspecific features. We describe a 57-year-old patient who presented with abdominal actinomycosis simulating colon cancer 6 years after liver transplantation. The main symptom was abdominal pain. Abdominal computed tomography and colonoscopy revealed an intraluminal 4.5 cm mass in the right colon, raising suspicions of a colonic malignancy and leading to surgical intervention. The postoperative pathologic study showed sulfur granules in the resected specimen compatible with abdominal actinomycosis. No signs of recurrence were seen throughout the 6-month follow-up. The literature on actinomycosis infections in immune-compromised hosts is reviewed. This presentation of actinomycosis in a liver transplant recipient has not been described previously, to our knowledge.
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Affiliation(s)
- I Laish
- Department of Internal Medicine A, Beilinson Hospital, Petah Tiqwa, Israel
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Sung HY, Lee IS, Kim SI, Jung SE, Kim SW, Kim SY, Chung MK, Kim WC, Oh ST, Kang WK. Clinical features of abdominal actinomycosis: a 15-year experience of a single institute. J Korean Med Sci 2011; 26:932-7. [PMID: 21738348 PMCID: PMC3124725 DOI: 10.3346/jkms.2011.26.7.932] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2010] [Accepted: 04/25/2011] [Indexed: 11/20/2022] Open
Abstract
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.
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Affiliation(s)
- Hye Young Sung
- Division of Gastroenterology, Department of Internal Medicine, Seoul St. Mary Hospital, the Catholic University of Korea College of Medicine, Seoul, Korea
- Health Improvement Center, Seoul St. Mary Hospital, the Catholic University of Korea College of Medicine, Seoul, Korea
| | - In Seok Lee
- Division of Gastroenterology, Department of Internal Medicine, Seoul St. Mary Hospital, the Catholic University of Korea College of Medicine, Seoul, Korea
| | - Sang Il Kim
- Division of Infection, Department of Internal Medicine, Seoul St. Mary Hospital, the Catholic University of Korea College of Medicine, Seoul, Korea
| | - Seung Eun Jung
- Department of Radiology, Seoul St. Mary Hospital, the Catholic University of Korea College of Medicine, Seoul, Korea
| | - Sang Woo Kim
- Division of Gastroenterology, Department of Internal Medicine, Seoul St. Mary Hospital, the Catholic University of Korea College of Medicine, Seoul, Korea
| | - Su Young Kim
- Department of Pathology, Seoul St. Mary Hospital, the Catholic University of Korea College of Medicine, Seoul, Korea
| | - Mun Kyung Chung
- Division of Gastroenterology, Department of Internal Medicine, Seoul St. Mary Hospital, the Catholic University of Korea College of Medicine, Seoul, Korea
- Health Improvement Center, Seoul St. Mary Hospital, the Catholic University of Korea College of Medicine, Seoul, Korea
| | - Won Chul Kim
- Division of Gastroenterology, Department of Internal Medicine, Seoul St. Mary Hospital, the Catholic University of Korea College of Medicine, Seoul, Korea
| | - Seong Tack Oh
- Department of Surgery, Seoul St. Mary Hospital, the Catholic University of Korea College of Medicine, Seoul, Korea
| | - Won Kyung Kang
- Department of Surgery, Seoul St. Mary Hospital, the Catholic University of Korea College of Medicine, Seoul, Korea
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Bae JH, Song R, Lee A, Park JS, Kim MR. Computed tomography for the preoperative diagnosis of pelvic actinomycosis. J Obstet Gynaecol Res 2011; 37:300-4. [DOI: 10.1111/j.1447-0756.2010.01336.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Privitera A, Milkhu CS, Datta V, Rodriguez-Justo M, Windsor A, Cohen CR. Actinomycosis of the sigmoid colon: A case report. World J Gastrointest Surg 2009; 1:62-4. [PMID: 21160798 PMCID: PMC2999117 DOI: 10.4240/wjgs.v1.i1.62] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2009] [Revised: 09/15/2009] [Accepted: 09/22/2009] [Indexed: 02/06/2023] Open
Abstract
Abdominal actinomycosis is a chronic suppurative infection caused by Actinomyces species. The ileo-cecal region is most commonly affected, while the left side of the colon is more rarely involved. The infection has a tendency to infiltrate adjacent tissues and is therefore rarely confined to a single organ. Presentation may vary from non specific symptoms and signs to an acute abdomen. A computed tomography scan is helpful in identifying the inflammatory process and the organs involved. It also allows visual guidance for percutaneous drainage of abscesses, thus aiding diagnosis. Culture is difficult because of the anaerobic character and slow growth of actinomycetes. Colonoscopy is usually normal, but may shows signs of external compression. Preoperative diagnosis is rare and is established only in less than 10% of cases. In uncomplicated disease, high dose antibiotic therapy is the mainstay of treatment. Surgery is often performed because of a difficulty in diagnosis. Surgery and antibiotics are required in the case of complicated disease. Combined medical and surgical treatment achieves a cure in about 90% of cases. The authors report a case of sigmoid actinomycosis where diagnosis was made from the histology, and a review of the literature is presented.
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Affiliation(s)
- Antonio Privitera
- Antonio Privitera, Charanjit Singh Milkhu, Vivek Datta, Alastair Windsor, Charles Richard Cohen, Department of Surgery, University College London Hospitals, London NW1 2BU, United Kingdom
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Choi MM, Beak JH, Lee JN, Park S, Lee WS. Clinical features of abdominopelvic actinomycosis: report of twenty cases and literature review. Yonsei Med J 2009; 50:555-9. [PMID: 19718405 PMCID: PMC2730619 DOI: 10.3349/ymj.2009.50.4.555] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2008] [Revised: 11/01/2008] [Accepted: 11/10/2008] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Intrabdominal actinomycosis is difficult to diagnose preoperatively. This chronic infection has a propensity to mimic many other diseases and may present with a wide variety of symptoms. The aim of this study was to evaluate the characteristic clinical features with review of the literature. MATERIALS AND METHODS We retrospectively analyzed 22 patients with intrabdominal actinomycosis between January 2000 and January 2006. RESULTS There were two men and 20 women with a mean age of 42.8 years (range, 24-69). Twelve patients presented with masses or abdominal pain, whereas 3 patients presented with acute appendicitis. The rate of performing an emergency surgery was 50% due to symptoms of peritonitis. The mean size of tumor was 5.5 cm (range, 2.5-11.0). Sixty percent (n = 12) of female patients had intrauterine device (IUD). The average time to definite diagnosis was 10.6 days. CONCLUSION Intrabdominal abdominal actinomycosis must first be suspected in any women with a history of current or recent IUD use who presents abdominal pain. If recognized preoperatively, a limited surgical procedure, may spare the patient from an extensive operation.
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Affiliation(s)
- Myung-Min Choi
- Department of Surgery, Gil Medical Center, Gachon University of Medicine and Science, Seoul, Korea
| | - Jeong Heum Beak
- Department of Surgery, Gil Medical Center, Gachon University of Medicine and Science, Seoul, Korea
| | - Jung Nam Lee
- Department of Surgery, Gil Medical Center, Gachon University of Medicine and Science, Seoul, Korea
| | - Sanghui Park
- Department of Pathology, Gil Medical Center, Gachon University of Medicine and Science, Seoul, Korea
| | - Won-Suk Lee
- Department of Surgery, Gil Medical Center, Gachon University of Medicine and Science, Seoul, Korea
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Ko TL, Li YT, Chu YC, Chen TH, Chen CS, Chen FM, Kuo TC. An Uncommon Case of Pelvic and Abdominal Wall Mass: Presumed Pelvic Actinomycosis. Taiwan J Obstet Gynecol 2007; 46:299-303. [PMID: 17962117 DOI: 10.1016/s1028-4559(08)60041-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Kayikcioglu F, Akif Akgul M, Haberal A, Faruk Demir O. Actinomyces infection in female genital tract. Eur J Obstet Gynecol Reprod Biol 2005; 118:77-80. [PMID: 15596277 DOI: 10.1016/j.ejogrb.2004.04.025] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2003] [Revised: 04/14/2004] [Accepted: 04/26/2004] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To analyze clinical and laboratory characteristics of patients with pelvic actinomyces. STUDY DESIGN We studied five patients with pelvic actinomyces who were admitted between January 1, 2002 and December 31, 2002. The initial complaints, diagnostic methods, therapeutic alternatives and results of the therapies were examined. RESULTS The ages of the cases varied between 32 and 52 years old. All five patients had been using an intrauterine device. Three cases had hydronephrosis due to infection. Two patients were diagnosed postoperatively while the other three cases were diagnosed with cervical smear and endometrial biopsy; penicillin G was administered to all. The patients are still under surveillance, and without any problems. CONCLUSION In patients with an intrauterine device, actinomyces should be remembered in differential diagnosis of pelvic infections. Preoperative diagnosis is of the utmost importance in order to prevent morbidity of this infiltrative infection. Long-term penicillin therapy proved to be successful. Complicated or resistant cases to medical therapy should be candidates for surgical therapy.
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Affiliation(s)
- Fulya Kayikcioglu
- Department of Gynecology, SSK Ankara Maternity and Women's Health Teaching Hospital, Etlik, TR06010 Ankara, Turkey.
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Abstract
Intra-abdominal and extraperitoneal actinomycosis are rare infections, caused by different Actinomyces species. However, they have been diagnosed more frequently in the last ten years. We report three cases of abdominal actinomycosis and a literature review of the last eight years. All three patients were diagnosed by means of histopathologic examination only. In one case, an intrauterine device (IUD) was associated with the infection. Therapy consisted of surgical resection of the inflammatory, infected tissue, and long-term antibiotic therapy. All patients are free of recurrence. Abdominal actinomycosis should be included in the differential diagnosis of an abdominal pathology of insidious onset, especially when an IUD is in place. Even when infection had spread extensively, combined operative and antibiotic therapy cured most of the cases.
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Abstract
INTRODUCTION We report two patients with actinomycosis of the appendix extending to the caecum and the ileum, and diagnosed postoperatively on histological analysis, the authors reviewed the literature. EXEGESIS Actinomycosis of the appendix can be acute or chronic. Diagnosis may be obtained preoperatively on the analysis of aspiration or biopsy material under CT scan control. It is frequently done postoperatively on the analysis of surgical specimen. Actinomycosis can be treated with antibiotics only during six months if the diagnosis is made preoperative, by surgery followed by antibiotics during 6-12 months, according to the extension of the actinomycosis, if the diagnosis is made after surgery, and by a combination of a surgery and antibiotics in complex forms. CONCLUSION Actinomycosis of the appendix is an infrequent pathology that merits to be known. With antibiotic therapy, we can avoid surgery or wide resections.
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Affiliation(s)
- E Habib
- Service de chirurgie viscérale et thoracique, hôpital Robert-Ballanger, 93602 Aulnay-sous-Bois, France.
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Affiliation(s)
- Y M Lee
- Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong
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Yegüez JF, Martinez SA, Sands LR, Hellinger MD. Pelvic Actinomycosis Presenting as Malignant Large Bowel Obstruction: A Case Report and a Review of the Literature. Am Surg 2000. [DOI: 10.1177/000313480006600118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Actinomycosis is an infrequent chronic infectious disease. In most cases the diagnosis is made postoperatively because of its unusual clinical presentation. Moreover, abdominal actinomycosis may mimic cancer, inflammatory bowel disease, or diverticulitis. Delay in diagnosis leading to inadequate management and unnecessary procedures has been reported. We report the case of a 49-year-old woman with large bowel obstruction secondary to extensive pelvic actinomycosis involving the rectosigmoid and cecum. She required emergency surgery, which involved both resection and colostomy. A review of the literature on abdominal actinomycosis during the last 50 years is also reported. Rarely has emergency surgery been described in this condition. Although the incidence of actinomycosis has decreased, the abdominal-pelvic form has been increasing over the past 10 years secondary to increased prolonged use of the intrauterine device. As the clinical spectrum of actinomycosis has dramatically changed, so have the therapeutic considerations. Aggressive surgical management in advanced cases with multiorganic involvement seems to have reemerged in recent years. Consideration of actinomycosis in a woman with prolonged use of an intrauterine device and symptoms of bowel obstruction could help to improve the preoperative diagnosis and management of this rare disease.
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Affiliation(s)
- José F. Yegüez
- Division of Colon and Rectal Surgery, Department of Surgery, University of Miami/Jackson Memorial Medical Center, Miami, Florida
| | - Sergio A. Martinez
- Division of Colon and Rectal Surgery, Department of Surgery, University of Miami/Jackson Memorial Medical Center, Miami, Florida
| | - Laurence R. Sands
- Division of Colon and Rectal Surgery, Department of Surgery, University of Miami/Jackson Memorial Medical Center, Miami, Florida
| | - Michael D. Hellinger
- Division of Colon and Rectal Surgery, Department of Surgery, University of Miami/Jackson Memorial Medical Center, Miami, Florida
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