Hajri M, Omrani S, Ferjaoui W, Mestiri H, Bayar R. Actinomycosis mimicking a pancreatic head neoplasm: A case report.
Int J Surg Case Rep 2022;
91:106794. [PMID:
35086048 PMCID:
PMC8802006 DOI:
10.1016/j.ijscr.2022.106794]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 01/17/2022] [Accepted: 01/20/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction
Actinomycosis is a chronic suppurative disease caused by a filamentous, Gram-positive, facultative anaerobic bacterium Actinomyces. Abdominal actinomycosis accounts for 10 to 20% of reported Actinomyces infections and pancreatic involvement is extremely rare.
Presentation of case
We report the case of a 64-year-old man who presented with a 3-week history of abdominal pain, nausea, weight loss, and icterus. Abdominal CT scan revealed a 3.5 cm heterogeneously enhanced mass of the pancreatic head, associated with mild dilation of the main bile duct and the Wirsung duct. The diagnosis of pancreatic head malignancy was highly suspected and surgical management was decided. Intraoperatively, a 3 cm indurated mass of the pancreatic head was found. Whipple's procedure was performed. Histopathological examination revealed pancreatic actinomycosis.
Discussion
Pancreatic actinomycosis is extremely rare. To our knowledge, only 18 cases have been reported in the English literature to date. It commonly presents as a slow-growing mass with bile and pancreatic ducts obstruction, which can mimic malignancy. Therefore, it has often been misdiagnosed and over-treated with futile surgery, when medical treatment based on antibiotherapy is the only required treatment.
Conclusion
We reported a rare observation of surgical management of actinomycosis mimicking a pancreatic head neoplasm. As clinical and radiological findings are nonspecific, the accurate diagnosis can only be made by histology. Through our case, we aim to highlight the importance of preoperative suspicion of pancreatic actinomycosis, given the still relevant morbidity of pancreatic resections.
Actinomycosis is a chronic suppurative disease caused by a filamentous, Gram-positive bacterium Actinomyces
Pancreatic actinomycosis is extremely rare
It commonly presents as a slow-growing mass which can mimic malignancy
Treatment is based on intravenous penicillin followed by oral penicillin for 6 to 12 months.
Preoperative diagnosis of pancreatic actinomycosis is important, given the still relevant morbidity of pancreatic resections
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