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Manterola C, Grande L, Riffo‐Campos ÁL, Salgado C, Otzen T. Clinical aspects of abdominal actinomycosis: a systematic review. ANZ J Surg 2020; 90:1465-1468. [DOI: 10.1111/ans.16141] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/19/2020] [Accepted: 06/23/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Carlos Manterola
- Department of SurgeryUniversidad de La Frontera Temuco Chile
- Center of Excellence in Morphological and Surgical Studies (CEMyQ)Universidad de La Frontera Temuco Chile
- PhD Program in Medical SciencesUniversidad de La Frontera Temuco Chile
| | - Luis Grande
- Department of SurgeryHospital del Mar/Institut Hospital del Mar d'Investigacions Mèdiques Barcelona Spain
- Department of SurgeryUniversitat Autònoma de Barcelona Barcelona Spain
| | | | - Carla Salgado
- Department of MedicineUniversidad del Azuay Cuenca Ecuador
| | - Tamara Otzen
- Center of Excellence in Morphological and Surgical Studies (CEMyQ)Universidad de La Frontera Temuco Chile
- PhD Program in Medical SciencesUniversidad de La Frontera Temuco Chile
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Asiri BI, Alshehri AA, Alqahtani AS, Albishi AM, Assiri YI, Asmiri EA. Caecum actinomycosis with acute abdomen: A case report. J Taibah Univ Med Sci 2020; 15:148-152. [PMID: 32368212 PMCID: PMC7184210 DOI: 10.1016/j.jtumed.2020.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 01/19/2020] [Accepted: 01/20/2020] [Indexed: 11/19/2022] Open
Abstract
Abdominal actinomycosis, one of the causes of ileocaecal disorders, is usually considered when other more common clinical conditions have been excluded. Actinomycosis is a rare infectious bacterial disorder caused by the Actinomyces species. We present the case of a 38-year male Saudi soldier who presented with pain in the right iliac fossa since 4 days prior to presentation. This stabbing pain started gradually. Based on clinical examination and abdominal ultrasound findings, an appendectomy was performed. Histological examination revealed appendicular actinomycosis with lymphoid hyperplasia, serosa congestion, and filamentous bacteria in the appendicular lumen. The patient was treated with amoxicillin. During follow-up, contrast-enhanced abdominal computed tomography (CT) and magnetic resonance imaging (MRI) revealed a 4.3 × 2.9 cm thickened caecal wall. Thereafter, the patient underwent laparoscope-assisted ileocaecal resection with ileocolic anastomosis. The histological report revealed calcified food material in the diverticulum, with chronic inflammation without actinomycosis, which may have been eradicated by the previous antibiotic treatment.
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Affiliation(s)
- Bader I. Asiri
- Internal Medicine, Armed Forces Hospital Southern Region, KSA
- Corresponding address: Internal Medicine, Armed Forces Hospital Southern Region Armed Forces Hospital Southern Region, KSA.
| | - Ali A. Alshehri
- Infectious Diseases, Armed Forces Hospital Southern Region, KSA
| | | | - Abdullah M. Albishi
- Internal Medicine, Gastrology and Endoscopy, Armed Forces Hospital Southern Region, KSA
| | - Yahia I. Assiri
- Radiology, College of Medicine in King Khalid University, KSA
| | - Esam A. Asmiri
- Internal Medicine, Armed Forces Hospital Southern Region, KSA
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Kim S, Kang SI, Kim S, Jang MH, Kim JH. Abdominopelvic Actinomycosis Mimicking Peritoneal Carcinomatosis: A Case Report. Ann Coloproctol 2019; 36:417-420. [PMID: 32054258 PMCID: PMC7837399 DOI: 10.3393/ac.2019.11.07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 11/07/2019] [Indexed: 10/25/2022] Open
Abstract
Actinomycosis is a rare chronic bacterial infection primarily caused by Actinomyces israelii. A 47-year-old woman presented to our clinic with a 1-week history of lower abdominal pain. Preoperative imaging studies revealed multiple peritoneal and pelvic masses suggestive of malignancy. The primary tumor could not be identified despite further endoscopic and gynecological evaluation. On exploration for tissue confirmation, excisional biopsies from multiple masses were performed because complete excision was not possible. Histopathological examination confirmed actinomycosis with multiple abscesses, and the patient was treated with antibiotics. We present a case of disseminated peritoneal actinomycosis that mimicked malignant peritoneal carcinomatosis on imaging studies.
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Affiliation(s)
- Sungjin Kim
- Department of Surgery, Yeungnam University Medical Center, Daegu, Korea
| | - Sung Il Kang
- Department of Surgery, Yeungnam University Medical Center, Daegu, Korea
| | - Sohyun Kim
- Department of Surgery, Yeungnam University Medical Center, Daegu, Korea
| | - Min Hye Jang
- Department of Pathology, Yeungnam University Medical Center, Daegu, Korea
| | - Jae Hwang Kim
- Department of Surgery, Yeungnam University Medical Center, Daegu, Korea
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Roh YH, Park KJ, Byun KD, Roh MS, Choi HJ. Abdominal actinomycosis misconceived as intestinal lymphoma: Report of a case. Int J Surg Case Rep 2019; 60:171-174. [PMID: 31229771 PMCID: PMC6597478 DOI: 10.1016/j.ijscr.2019.05.063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 05/29/2019] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Abdominal actinomycosis is a rare clinical entity and it is difficult to make the correct preoperative diagnosis because of its nonspecific clinical symptoms and varied radiological findings. The diagnosis is usually made after the patient undergoes an operation and tissue is available for pathological evaluation. When the diagnosis is made, the patient should be treated with the appropriate long-term antibiotics. PRESENTATION OF CASE A 69-year-old male patient was transferred to our hospital complaining of a palpable mass, painful abdominal discomfort, weight loss, and night sweating. After colonoscopy and radiologic studies, our presumptive diagnosis was intestinal lymphoma combined with ileocecal intussusception. He was found to have abdominal actinomycosis after surgery and successfully treated with ampicillin for six months. DISCUSSION Pre-operative radiological imaging in abdominal actinomycosis is unlikely to allow a definitive diagnosis, but CT scanning is the single most useful imaging modality. Although we performed preoperative radiological studies, including CT, none led to a diagnosis of abdominal actinomycosis, we mistakenly considered the case as intestinal lymphoma combined with ileocecal intussusception. CONCLUSION Physicians should include abdominal actinomycosis in the differential diagnosis when an abdominal mass presents an irregular, infiltrative growth pattern, even though ileocecal intussusception is an extremely rare presentation in abdominal actinomycosis.
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Affiliation(s)
- Young-Hoon Roh
- Department of Surgery, Dong-A University College of Medicine, Busan, Republic of Korea
| | - Ki-Jae Park
- Department of Surgery, Dong-A University College of Medicine, Busan, Republic of Korea.
| | - Kyung-Do Byun
- Department of Surgery, Dong-A University College of Medicine, Busan, Republic of Korea
| | - Mee-Sook Roh
- Department of Pathology, Dong-A University College of Medicine, Busan, Republic of Korea
| | - Hong-Jo Choi
- Department of Surgery, Dong-A University College of Medicine, Busan, Republic of Korea
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Al-Obaidy K, Alruwaii F, Al Nemer A, Alsulaiman R, Alruwaii Z, Shawarby MA. Primary gastric actinomycosis: report of a case diagnosed in a gastroscopic biopsy. BMC Clin Pathol 2015; 15:2. [PMID: 25774092 PMCID: PMC4359583 DOI: 10.1186/s12907-015-0002-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 02/09/2015] [Indexed: 12/03/2022] Open
Abstract
Background Primary gastric actinomycosis is extremely rare, the appendix and ileocecal region being the most commonly involved sites in abdominopelvic actinomycosis. Herein, we report a case of primary gastric actinomycosis. The diagnosis was made on microscopic evaluation of gastroscopic biopsy specimens. To the best of our knowledge, this is the third case to be reported in the literature, in which the diagnosis was made in a gastroscopic biopsy rather than a resection specimen. Case presentation An 87-year-old Saudi male on medication for cardiomyopathy, premature ventricular contractions, renal impairment, hypertension, and dyslipidemia, presented to the emergency department with acute diffuse abdominal pain, abdominal distension, constipation and vomiting for two days, with no history of fever, abdominal surgery or trauma. The patient was admitted to the hospital with an impression of gastric outlet obstruction. Based on radiologic and gastroscopic findings, a non-infectious etiology was suspected, possibly adenocarcinoma or lymphoma. Gastroscopic biopsies showed an actively inflamed, focally ulcerated atrophic fundic mucosa along with fragments of a fibrinopurulent exudate containing brownish, iron negative pigment and abundant filamentous bacteria, morphologically consistent with Actinomyces. Conclusion Althuogh extremely rare, primary gastric actinomycosis should be considered in the differential diagnosis of radiologic and gastroscopic diffuse gastric wall thickening and submucosal tumor-like or infiltrative lesions, particularly in patients with history of abdominal surgery or trauma, or those receiving extensive medication. A high level of suspicion is required by the pathologist to achieve diagnosis in gastroscopic biopsies. Subtle changes such as the presence of a pigmented inflammatory exudate should alert the pathologist to perform appropriate special stains to reveal the causative organism.
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Affiliation(s)
- Khaleel Al-Obaidy
- Pathology Department, College of Medicine, University of Dammam, P.O. Box 1982, Dammam, 31441 Saudi Arabia
| | - Fatimah Alruwaii
- Pathology Department, College of Medicine, University of Dammam, P.O. Box 1982, Dammam, 31441 Saudi Arabia
| | - Areej Al Nemer
- Pathology Department, College of Medicine, University of Dammam, P.O. Box 1982, Dammam, 31441 Saudi Arabia
| | - Raed Alsulaiman
- Department of Internal Medicine, College of Medicine, University of Dammam, P.O. Box 1982, Dammam, 31441 Saudi Arabia
| | - Zainab Alruwaii
- King Fahd Hospital of the University, University of Dammam, P.O. Box 2208, Al-Khobar, 31952 Saudi Arabia
| | - Mohamed A Shawarby
- Pathology Department, College of Medicine, University of Dammam, P.O. Box 1982, Dammam, 31441 Saudi Arabia
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Montori G, Allegri A, Merigo G, Poiasina P, Coccolini F, Manfredi R, Piazzalunga D, Tebaldi A, Filippin F, Gianatti A, Baiocchi L, Portolani N, Ansaloni L. Intra-abdominal actinomycosis, the great mime: case report and literature review. ACTA ACUST UNITED AC 2015. [DOI: 10.7243/2052-6229-3-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Yilmaz M, Akbulut S, Samdanci ET, Yilmaz S. Abdominopelvic actinomycosis associated with an intrauterine device and presenting with a rectal mass and hydronephrosis: a troublesome condition for the clinician. Int Surg 2012; 97:254-9. [PMID: 23113856 PMCID: PMC3723221 DOI: 10.9738/cc121.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Actinomycosis is an uncommon, chronic, granulomatous disease that can be mistaken for a malignant tumor. Abdominopelvic actinomycosis constitutes about 20% of all actinomycosis cases and may mimic malignancy, tuberculosis, or other abdominopelvic inflammatory diseases. This condition is more prevalent in women who use an intrauterine device. We treated a 44-year-old woman who presented with vaginal discharge, right flank pain, dysuria, and difficulty with defecation. She had anorexia and weight loss (8 kg) during the previous 2 months and had a history of intrauterine device use for 12 years. Clinical, radiologic, and endoscopic examinations revealed a rectal mass and right hydronephrosis. Rectal biopsy showed nonspecific colitis. Laparotomy showed a mass that was invading and obstructing the pelvic orifice. Surgery included total abdominal hysterectomy, bilateral salpingo-oophorectomy, appendectomy, low anterior resection, and Hartmann colostomy. Histopathologic evaluation of surgical specimens showed actinomycosis originating from the tubo-ovarian structures and invading the rectal wall. The patient was placed on penicillin for 6 months, and then had closure of the colostomy with no complication.
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Affiliation(s)
- Mehmet Yilmaz
- Department of Surgery, Division of Liver Transplantation Inonu, University Faculty of Medicine, 44280, Malatya, Turkey
| | - Sami Akbulut
- Department of Surgery, Division of Liver Transplantation Inonu, University Faculty of Medicine, 44280, Malatya, Turkey
- Reprint requests: Sami Akbulut, MD, Department of Surgery, Division of liver Transplantation, Inonu University Faculty of Medicine, 44280, Malatya, Turkey. Tel.: +90422 3410660, Fax: +90422 3410036; E-mail:
| | | | - Sezai Yilmaz
- Department of Surgery, Division of Liver Transplantation Inonu, University Faculty of Medicine, 44280, Malatya, Turkey
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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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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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Sharman MJ, Goh CS, Kuipers von Lande RG, Hodgson JL. Intra-abdominal actinomycetoma in a cat. J Feline Med Surg 2009; 11:701-5. [PMID: 19181557 PMCID: PMC11132574 DOI: 10.1016/j.jfms.2008.10.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2008] [Indexed: 11/30/2022]
Abstract
A 5-year-old, female Ragdoll cat was diagnosed with an intra-abdominal mycetoma involving the ileocaecal region. Diagnosis was obtained via histopathological examination following surgical resection of the mass and an ileocolic anastomosis. The initial surgery was complicated by lymphangiectasia, chylous abdominal effusion and mild bacterial leakage from the anastomosis site. A second, exploratory laparotomy was performed to augment the anastomosis with serosal patching and omentalisation and to investigate a cystic structure observed on follow-up abdominal ultrasound. Initial amoxycillin clavulanate (Clavulox; Pfizer Animal Health) therapy was ineffective, but clindamycin (Antirobe; Pfizer Animal Health) proved successful in resolving the infection. Abdominal actinomycetoma in the cat may be an under-diagnosed condition due to its close resemblance to neoplastic disease. Standard diagnostic and therapeutic regimens are commonly ineffective in Actinomyces species infections. Surgical resection along with adjunctive, long-term, selective antimicrobial therapy is effective and prognosis is good for localised lesions.
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Affiliation(s)
- Mellora J Sharman
- University Veterinary Centre, Faculty of Veterinary Science, The University of Sydney, Werombi Road, Camden, New South Wales 2570, Australia.
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Colović R, Grubor N, Micev M, Latincić S, Matić S, Colović N. [Actinomycosis of the caecum simulating carcinoma in a patient with a long-term intrauterine device]. SRP ARK CELOK LEK 2009; 137:285-7. [PMID: 19594073 DOI: 10.2298/sarh0906285c] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Actinomycosis of the caecum is a rare, but most frequently an abdominally localized disease. It often simulates inflammatory malignancy, rarely a periappendicular abscess or Chron's disease and is only exceptionally the cause of intestinal obstruction or bleeding. CASE OUTLINE The authors present a 35-year-old woman with an intrauterine device which remained inserted for over three years, causing the development of pain, fever, vaginal secretion and bleeding that continued even after the device was removed. Ultrasonography showed a tumorous mass of irregular form located close to the uterus, which after a few months developed into a colliquation filled with pus requiring incision. Bacteriological examination failed to show actinomycosis. Due to the tumorous lesions involving the terminal ileum, appendix, caecum, ascending colon and omentum, a right hemicolectomy was performed. Based on histolopathological findings of the resected sample the diagnosis of actinomycosis was made. Therefore, after surgery the patient began treatment with antibiotics resulting in full recovery. CONCLUSION Although rare, actinomycosis of the caecum should be taken into consideration in the differential diagnosis of tumorous lesions of the caecoascending part of the colon, particularly if the tumour is associated with inflammation.
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Barquero-Romero J, García García G, Isaac Ambel Albarrán E. Seudocarcinoma de colon por colitis isquémica tras un tratamiento radioterápico. GASTROENTEROLOGIA Y HEPATOLOGIA 2008; 31:49-50. [DOI: 10.1157/13114569] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Baierlein SA, Wistop A, Looser C, Peters T, Riehle HM, von Flüe M, Peterli R. Abdominal actinomycosis: a rare complication after laparoscopic gastric bypass. Obes Surg 2007; 17:1123-6. [PMID: 17953250 DOI: 10.1007/s11695-007-9189-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
A 33-year-old, morbidity obese woman underwent a laparoscopic Roux-en-Y gastric bypass in November 2004. She presented 18 months later with a history of recurrent pain in the upper region of the abdomen and severe vomiting. Radiologic and endoscopic evaluations revealed wall thickening in the transverse colon and a solid tumor near the liver. Therefore, a sonography-guided biopsy of the tumor was performed. Cytopathological examination revealed actinomycosis. Thus, therapy with penicillin was started, after which the parameters associated with the infection decreased. The symptoms persisted, however, and the decision was made to operate on the patient to resect the abdominal masses. Nearly 90% of the masses could be removed. Histological analysis showed a fibro-productive inflammation with an actinomycotic etiology. Antibiotic therapy with penicillin was continued for 6 months. Actinomycosis must be considered in the differential diagnosis of patients with abdominal mass, wall thickening of the intestine, and other such symptoms, including abdominal pain following bariatric surgery, even many years after the intervention.
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