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Touati MD, Saidani A, Kallel MA, Brahem E, Belhadj A, Chebbi F. Actinomycosis as a rare cause of acute appendicitis: Case report and comprehensive literature review. Int J Surg Case Rep 2024; 121:109975. [PMID: 38941730 PMCID: PMC11260565 DOI: 10.1016/j.ijscr.2024.109975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Revised: 06/23/2024] [Accepted: 06/26/2024] [Indexed: 06/30/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Actinomycosis is a rare, chronic bacterial infection caused by Actinomyces species. While it commonly affects the cervicofacial region, thorax, and abdomen, appendicular involvement is extremely uncommon. This case report details the presentation, diagnosis, and management of a 45-year-old female patient with acute appendicitis secondary to actinomycosis. CASE PRESENTATION A 45-year-old woman, with an 8-year intrauterine device history, presented with three-day right iliac fossa pain, vomiting, and stable vital signs. Laboratory tests revealed an inflammatory syndrome. Suspecting acute appendicitis, a CT scan confirmed a swollen 10 mm appendix. Laparoscopic surgery revealed a phlegmonous appendix, leading to an uncomplicated appendectomy. Pathological examination confirmed actinomycotic granules, supporting the diagnosis of actinomycosis appendicitis. The patient received 18 million units of intravenous penicillin G daily for 6 weeks followed by a 6-month course of oral amoxicillin (1 g three times daily) thereafter, showing favorable progression with no symptoms. Normal clinical and ultrasound follow-ups were observed at one year. CLINICAL DISCUSSION Appendiceal actinomycosis is a rare condition. Women, especially those with intrauterine contraceptives, experience an increase in cases due to chronic inflammation. Typically underdiagnosed, actinomycosis mimics other conditions, presenting with nonspecific symptoms. Laboratory results offer limited assistance, and histological confirmation is crucial. Histopathological examination is mandatory for diagnosis confirmation. Management involves surgical resection and prolonged penicillin-based antibiotics, providing a favorable prognosis with low mortality. CONCLUSION This case underscores the importance of considering rare etiologies, such as actinomycosis, in the differential diagnosis of appendicitis. Timely recognition and management are crucial for optimal patient outcomes.
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Affiliation(s)
- Med Dheker Touati
- General Surgery Department, Mahmoud El Matri Hospital, V59M+628, Ariana, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, R534+F9H, Rue de la Faculté de Médecine, Tunis, Tunisia.
| | - Ahmed Saidani
- General Surgery Department, Mahmoud El Matri Hospital, V59M+628, Ariana, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, R534+F9H, Rue de la Faculté de Médecine, Tunis, Tunisia
| | - Med Ali Kallel
- General Surgery Department, Mahmoud El Matri Hospital, V59M+628, Ariana, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, R534+F9H, Rue de la Faculté de Médecine, Tunis, Tunisia
| | - Emna Brahem
- Department of Pathological Anatomy and Cytology, Abderrahmen-Mami Hospital, Ariana, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, R534+F9H, Rue de la Faculté de Médecine, Tunis, Tunisia
| | - Anis Belhadj
- General Surgery Department, Mahmoud El Matri Hospital, V59M+628, Ariana, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, R534+F9H, Rue de la Faculté de Médecine, Tunis, Tunisia
| | - Faouzi Chebbi
- General Surgery Department, Mahmoud El Matri Hospital, V59M+628, Ariana, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, R534+F9H, Rue de la Faculté de Médecine, Tunis, Tunisia
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Zhang N, Zhou K, Gao X, Duan X, Yang S, Kang L. Clinical Features of Actinomycosis in Older Adults: A 10-Year Experience of a Single Institute in Beijing, China. Cureus 2024; 16:e65734. [PMID: 39082044 PMCID: PMC11288168 DOI: 10.7759/cureus.65734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Actinomycosis is a rare infectious disease with non-specific clinical presentations often resulting in delayed diagnosis, especially in older adults. Diagnosing and treating actinomycetal infections in this population can be particularly challenging due to the lack of comprehensive case series studies focusing specifically on actinomycosis in older adults. The existing literature mainly consists of case reports, highlighting the need for more extensive research in this area. This study aimed to provide a profile of actinomycosis in older adults to guide future research efforts. METHODS Elderly patients aged 60 years and older who satisfied the inclusion criteria for actinomycosis at Peking Union Medical College Hospital from January 2014 to May 2024 underwent a retrospective analysis. The research centered on describing the clinical features and diagnostic techniques, distinguishing between different conditions, and treating clinically important instances of actinomycosis within this specific age bracket. RESULTS This study involved 22 patients, with a balanced gender distribution of 11 males and 11 females, aged between 60 and 84 years, and a median age of 67 years. The disease predominantly affected the thoracic region (n=17), followed by the abdominal-pelvic (n=2) and orocervicofacial (n=2) regions, along with one case involving soft tissue (n=1). Microbiological methods confirmed the diagnosis in 17 cases (77%), while histopathological examination was employed in the remaining five cases (23%). General symptoms, such as fever and weight loss, were reported by 64% of the patients, whereas 32% exhibited symptoms localized to the infection site. Only one patient (4%) did not present any symptoms. The median duration from the onset of initial symptoms to diagnosis was 120 days (IQR 34.5-240). Nine patients were successfully treated with antibiotics, with only one patient experiencing a relapse during the follow-up period. CONCLUSIONS Infections caused by actinomycetes are infrequent among the elderly and often exhibit non-specific clinical symptoms and imaging results. Among the various types of actinomycetal infections in this demographic, pulmonary actinomycosis is the most prevalent. Recognizing the wide-ranging capacity of actinomycetes to induce infections beyond our present knowledge is essential. It is important for healthcare practitioners to deepen their knowledge of actinomycosis to prevent delays in both diagnosis and treatment.
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Affiliation(s)
- Ning Zhang
- Department of Geriatrics, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, CHN
| | - Kanghao Zhou
- Department of Internal Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, CHN
| | - Xiu Gao
- Department of General Medicine, The First Hospital of Yulin City, Yulin, CHN
| | - Xinmin Duan
- Department of Infectious Diseases, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, CHN
| | - Shengmin Yang
- Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, CHN
| | - Lin Kang
- Department of Geriatrics, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, CHN
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Arslan RS, Koca YS, Beyoğlu R, Yenipazar AE. Appendecular actinomycosis: A case series of 14 patients. Med Clin (Barc) 2024; 162:500-504. [PMID: 38570296 DOI: 10.1016/j.medcli.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 02/08/2024] [Accepted: 02/12/2024] [Indexed: 04/05/2024]
Abstract
OBJECTIVE This study aims to assess the clinical, radiological, and histological characteristics of Actinomyces infection identified in appendectomy specimens. MATERIAL AND METHODS Between January 2013 and November 2023, 5834 patients underwent appendectomy in our clinic, and their pathology reports were retrospectively reviewed. RESULTS Actinomyces appendicites were reported in 14 specimens (0.23%). It was determined that appendectomy was performed in only 10 patients (71.4%), ileocecal resection was performed in two patients (14.2%) and right hemicolectomy in two patients (14.2%). The operations on five patients were performed by laparoscopy, and the operations on the other nine patients were performed by open surgery. Laparoscopy was started in three patients and converted to open surgery due to suspicion of an ileocecal mass and cecal perforation. It was found that the white blood cell count of three patients was within the normal range of reference (8-9.77mg/dL); leukocytosis was detected in other patients (10.2-18.7mg/dL). C-reactive protein was normal in one patient and high in the rest of the patients. While the first-hour erythrocyte sedimentation rate was normal in five patients, it was found to be high in the other patients. Findings on radiological imaging were reported as acute appendicitis, appendicular plastron, and ileocecal mass. As a result of the pathology findings, the patients were given oral penicillin or semi-synthetic penicillin derivatives during one month. CONCLUSION Ileocecal and appendecular actinomycosis are rare, and preoperative diagnosis is difficult. A definitive diagnosis is usually made after a histopathological examination. After surgery, long-term antimicrobial treatment of the patient is possible with penicillin.
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Affiliation(s)
| | - Yavuz Savaş Koca
- Servergazi State Hospital Department of General Surgery, Denizli, Turkey
| | - Reşad Beyoğlu
- Servergazi State Hospital Department of Emergency Medicine, Denizli, Turkey
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4
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Gao Y, Jhamb S, Hayler R, Trickett C, Kwok A. Actinomyces as a rare cause of appendicitis: a case report. J Surg Case Rep 2024; 2024:rjae195. [PMID: 38572291 PMCID: PMC10984727 DOI: 10.1093/jscr/rjae195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 03/09/2024] [Indexed: 04/05/2024] Open
Abstract
Actinomycosis remains a rare and often underdiagnosed cause of appendicitis with only 10% of cases diagnosed prior to surgery. It is an important cause to consider particularly in the setting of an indolent infection with nonspecific symptoms. We present a 22 years old male who presented with 3 weeks history of lower abdominal pain who underwent laboratory investigations and imaging studies suggestive of acute appendicitis. He underwent an emergency laparoscopic caecectomy with histopathology of the specimen suggestive of actinomycosis. He recovered well postoperatively and was discharged home with a prolonged course of oral penicillins. Preoperative diagnosis of actinomycosis is uncommon and accounts for ~10% of cases. Definitive diagnosis is usually through histopathology or tissue/fluid culture. Treatment usually involves a combination of surgical resection and antibiotic therapy with a success rate of >90%.
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Affiliation(s)
- Yijun Gao
- Department of Surgery, The Sutherland Hospital, The Kingsway, Caringbah 2229, NSW, Australia
| | - Shaurya Jhamb
- Department of Surgery, The Sutherland Hospital, The Kingsway, Caringbah 2229, NSW, Australia
| | - Raymond Hayler
- Department of Surgery, St George Public Hospital, Gray Street, Kogarah 2217, NSW, Australia
| | - Chloe Trickett
- Department of Surgery, The Sutherland Hospital, The Kingsway, Caringbah 2229, NSW, Australia
| | - Allan Kwok
- Department of Surgery, The Sutherland Hospital, The Kingsway, Caringbah 2229, NSW, Australia
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5
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Khabyeh-Hasbani N, Zino S, Dima E, Avital S. Appendiceal actinomycosis mimicking malignant tumor: a rare case report. Ann Med Surg (Lond) 2024; 86:1076-1079. [PMID: 38333266 PMCID: PMC10849298 DOI: 10.1097/ms9.0000000000001564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 11/20/2023] [Indexed: 02/10/2024] Open
Abstract
Introduction Actinomycosis is an uncommon bacterial infection caused by Actinomyces bacteria that typically progresses slowly and leads to the formation of masses. Although it commonly affects the cervicofacial area, about 20% of cases occur in the abdominopelvic region. Because the disease can be mistaken for a tumour due to its infiltrative mass-like nature on imaging, over 90% of cases are only diagnosed following surgery and histological confirmation. This report describes a case of an appendicular mass, initially suspected to be a malignant tumour, but eventually diagnosed as appendiceal actinomycosis. Presentation of case Upon initial presentation, a 53-year-old woman with type II diabetes mellitus and no prior surgical history, displayed abnormal appendiceal uptake during a PET-computed tomography (CT) scan conducted for a suspected spinal tumour. Colonoscopy did not indicate any notable observations, and the patient chose to defer immediate action. Several months later, a CT scan revealed an increased mass-like appearance of the appendix compared to the previous PET-CT scan. After multidisciplinary discussions, a right laparoscopic hemicolectomy was recommended due to suspected malignancy. However, histological staining on microscopy confirmed actinomycosis originating from the appendix. Discussion Chronic appendicitis with radiologic features similar to appendiceal carcinoma, or abdominal masses located in the ileocecal area, in patients with or without a previous surgical history should raise suspicion of actinomycosis. Conclusion Appendiceal actinomycosis should be considered in the differential diagnosis in the aetiology of chronic appendicitis mimicking appendiceal carcinoma. Awareness and accurate diagnosis of appendiceal actinomycosis can prevent unnecessary extended surgery as was performed in this case.
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Affiliation(s)
- Nathan Khabyeh-Hasbani
- Sackler School of Medicine, Tel Aviv University, Ramat Aviv
- Department of General Surgery, Meir Medical Center, Kfar Saba
| | - Sivan Zino
- Department of General Surgery, Meir Medical Center, Kfar Saba
| | - Elena Dima
- Department of Pathology, Maccabi Healthcare System
| | - Shmuel Avital
- Sackler School of Medicine, Tel Aviv University, Ramat Aviv
- Department of General Surgery, Meir Medical Center, Kfar Saba
- Department of Surgery, Assuta Medical Center, Tel Aviv, Israel
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6
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Bohara S, Khadka M, Bhat PS, Syangtang P, Karki B, Shrestha B, Acharya SA, Khetan K, Rayamajhi J, Rawal SB. Appendicular actinomycosis: The first reported case of an uncommon finding of a common ailment from Nepal. Clin Case Rep 2023; 11:e7996. [PMID: 37786458 PMCID: PMC10541570 DOI: 10.1002/ccr3.7996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/05/2023] [Accepted: 09/19/2023] [Indexed: 10/04/2023] Open
Abstract
Key Clinical Message Actinomycosis is a rare cause of appendicitis with an incidence of 0.3-1 incident per year per 100,000 people. A significant preoperative diagnostic challenge exists and is usually diagnosed incidentally on histopathological examination. Abstract Appendicular actinomycosis, a rare, chronic granulomatous infection caused by actinomyces species, holds a significant preoperative diagnostic summons and is often diagnosed serendipitously during the regular histopathological examination. Herein, we present a case of a 36-year-old female who presented with features suggestive of acute appendicitis, underwent laparoscopic appendicectomy, and was diagnosed with appendicular actinomycosis from the histopathological examination.
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Affiliation(s)
- Sujan Bohara
- Department of Cardiovascular SurgerySahid Gangalal National Heart CentreKathmanduNepal
| | - Manoj Khadka
- Department of SurgeryNepalese Army Institute of Health ScienceKathmanduNepal
| | - Pawan Singh Bhat
- Department of General and Gastrointestinal SurgeryNepal MedicitiLalitpurNepal
| | - Prajwal Syangtang
- Department of SurgeryNepalese Army Institute of Health ScienceKathmanduNepal
| | - Badal Karki
- Department of General SurgeryMadan Bhandari Hospital, and Trauma CenterUrlabariNepal
| | - Bhagawan Shrestha
- Department of SurgeryNepalese Army Institute of Health ScienceKathmanduNepal
| | | | - Khusbhu Khetan
- Department of Laboratory medicine and pathologyNepal MedicitiLalitpurNepal
| | - Jyoti Rayamajhi
- Department of General and Gastrointestinal SurgeryNepal MedicitiLalitpurNepal
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7
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Tendulkar SP, Jain PA, Mehta MG, George S. Appendiceal actinomycosis presenting as acute appendicitis: A diagnostic and therapeutic challenge. J Postgrad Med 2023; 69:63-64. [PMID: 36537395 PMCID: PMC9997601 DOI: 10.4103/jpgm.jpgm_196_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- S P Tendulkar
- Department of General and Minimal Access Surgery, Sir H.N. Reliance Foundation Hospital and Research Centre, Mumbai, Maharashtra, India
| | - P A Jain
- Department of General and Minimal Access Surgery, Sir H.N. Reliance Foundation Hospital and Research Centre, Mumbai, Maharashtra, India
| | - M G Mehta
- Department of General and Minimal Access Surgery, Sir H.N. Reliance Foundation Hospital and Research Centre, Mumbai, Maharashtra, India
| | - S George
- Department of Laboratory Medicine, Sir H.N. Reliance Foundation Hospital and Research Centre, Mumbai, Maharashtra, India
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8
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Completo S, Veríssimo M, M. G. Pereira A, França I, Sande Lemos P. Appendicular Actinomycosis: Behind the Curtains of Appendicitis. Cureus 2022; 14:e29709. [PMID: 36321040 PMCID: PMC9616551 DOI: 10.7759/cureus.29709] [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] [Accepted: 09/27/2022] [Indexed: 11/06/2022] Open
Abstract
Actinomycosis is a rare, indolent, and multisystemic infection caused by Actinomyces, commensal bacteria of the oral and intestinal flora. It usually occurs due to tissue disruption. It affects the abdominal region in 20% of cases, and the most common presentation is a perforated appendix. Symptoms are nonspecific, which makes differential diagnosis a challenge. We present the case of a healthy, nine-year-old boy of African ancestry with a five-month history of recurrent intermittent abdominal pain in the periumbilical and right lower quadrant areas. He recurred to the emergency department with symptoms suggestive of acute appendicitis and was submitted to an emergent laparotomy. The histologic examination revealed Actinomyces colonies compatible with the diagnosis of appendicular actinomycosis. He was treated with intravenous penicillin for a month and, subsequently, with oral amoxicillin for a year. He had complete remission of symptoms. Actinomycosis is a rare entity, particularly in children. Nevertheless, it should be considered in the differential diagnosis of an intrabdominal mass or unspecific recurrent, indolent, and abdominal pain. As symptoms are nonspecific, it can mimic other diseases. It is mostly diagnosed post-operatively, after histological examination. Early treatment is important to avoid recurrence, and, therefore, a high index of suspicion is required.
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Iqbal A, Fujimura T, Shinjoh M, Furuichi M, Iimori T, Umeyama T, Ishida T, Morinaga S, Kamimaki I, Ohkusu K, Takahashi T. The first case report of pediatric acute appendicitis caused by "Candidatus Actinobaculum timonae". J Infect Chemother 2021; 28:451-454. [PMID: 34887179 DOI: 10.1016/j.jiac.2021.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 11/21/2021] [Accepted: 11/24/2021] [Indexed: 11/16/2022]
Abstract
A 14-year-old boy presented to the hospital with pain in the right lower abdomen. His condition was diagnosed as acute appendicitis. An emergency operation was performed, and histopathological examination revealed an actinomycete-related organism in the excised appendicitis specimen. On 16S rRNA gene sequence analysis, "Candidatus Actinobaculum timonae" was identified, which is the first known case in a pediatric patient.
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Affiliation(s)
- Asef Iqbal
- Department of Pediatrics, National Hospital Organization Saitama Hospital, 2-1 Suwa, Wako city Saitama, Japan
| | - Takumi Fujimura
- Department of Pediatric Surgery, National Hospital Organization Saitama Hospital, 2-1 Suwa, Wako city Saitama, Japan
| | - Masayoshi Shinjoh
- Department of Pediatrics, Keio University School of Medicine, 35 Shinanomachi Shinjuku-ku, Tokyo, Japan.
| | - Munehiro Furuichi
- Department of Pediatrics, Keio University School of Medicine, 35 Shinanomachi Shinjuku-ku, Tokyo, Japan
| | - Takashi Iimori
- Department of Pediatrics, National Hospital Organization Saitama Hospital, 2-1 Suwa, Wako city Saitama, Japan
| | - Tomoshige Umeyama
- Department of Pediatric Surgery, Keio University School of Medicine, 35 Shinanomachi Shinjuku-ku, Tokyo, Japan
| | - Tsuyoshi Ishida
- Department of Diagnostic Pathology, National Hospital Organization Saitama Hospital, 2-1 Suwa, Wako city Saitama, Japan
| | - Shojiro Morinaga
- Department of Diagnostic Pathology, National Hospital Organization Saitama Hospital, 2-1 Suwa, Wako city Saitama, Japan
| | - Isamu Kamimaki
- Department of Pediatrics, National Hospital Organization Saitama Hospital, 2-1 Suwa, Wako city Saitama, Japan
| | - Kiyofumi Ohkusu
- Department of Microbiology, Tokyo Medical University, 6-1-1 Shinjuku Shinjuku-ku, Tokyo, Japan
| | - Takao Takahashi
- Department of Pediatrics, Keio University School of Medicine, 35 Shinanomachi Shinjuku-ku, Tokyo, Japan
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10
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Şenaylı A. Diagnosing granulomatous disease during appendectomy. Clin Case Rep 2021; 9:e05074. [PMID: 34815873 PMCID: PMC8593883 DOI: 10.1002/ccr3.5074] [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: 09/20/2021] [Revised: 10/12/2021] [Accepted: 10/26/2021] [Indexed: 12/29/2022] Open
Abstract
Difficulties during surgery are uncommon situations in appendectomy. For granulomatous appendicitis, literature is insufficient about surgical findings. The procedure of a 17-year-old male patient was a struggle due to adhesions. I thought a surgeon could expect granulomatous diseases by evaluating the macroscopic appearance of the appendix during surgical procedure.
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Affiliation(s)
- Atilla Şenaylı
- Faculty of MedicinePediatric Surgery DepartmentT.C. Yozgat Bozok UniversityYozgatTurkey
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11
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Sarici B, Akbulut S, Ozcan M, Demyati K, Samdanci E. Unusual infectious agents detected in appendectomy specimens: A retrospective analysis of 42 cases. Turk J Surg 2020; 36:291-296. [PMID: 33778385 PMCID: PMC7963316 DOI: 10.47717/turkjsurg.2020.4713] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 04/24/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the clinical and histopathological features of 42 patients with unusual infectious agents detected in their appendectomy specimens. MATERIAL AND METHODS Between January 1999 and November 2018, 2.754 patients underwent emergency or incidental appendectomy in our clinic, and their pathology reports were retrospectively reviewed. Unusual infectious agents or eosinophilic infiltration of the appendix were reported in the initial pathological examinations of 57 patients. The pathological slides of these patients were re-examined by histopathologists. The examinations revealed that 15 of these patients had no microscopic findings suggestive of parasitic infections. The remaining 42 patients with unusual appendiceal infectious agents were included into the study. RESULTS A total of 42 patients (25 females and 17 males) aged 18 to 75 years were included into this study. While 32 of these patients (76%) underwent emergency appendectomy with a presumed diagnosis of acute appendicitis (AAp), the remaining 10 patients underwent incidental appendectomy for various reasons. Twenty-two patients (52.4%) had histopathological changes consistent with AAp while 20 patients had no evidence of AAp. Histopathological examination revealed infection with Enterobius vermicularis in 38 of the patients, Taenia species in 2, and Ascaris lumbricoides and Actinomyces species in 1 patient each. A total of 24 patients were treated for infections with mebendazole (n = 20), albendazole (n =1), niclosamide (n = 2), and amoxicillin (n = 1). CONCLUSION Unusual infectious agents should be considered as factors potentially triggering AAp, especially in patients living in endemic areas. The appendiceal stump should be inspected for parasite residues.
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Affiliation(s)
- Baris Sarici
- Inonu University Faculty Of Medicine, Surgery, Malatya, Turkey
| | - Sami Akbulut
- Inonu University Faculty Of Medicine, Surgery, Malatya, Turkey
| | - Mehmet Ozcan
- Inonu University Faculty Of Medicine, Patholgoy, Malatya, Turkey
| | - Khaled Demyati
- An-najah National University, Suegery, Nablus, Palestinian Territories
| | - Emine Samdanci
- Inonu University Faculty Of Medicine, Patholgoy, Malatya, Turkey
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Sung YN, Kim J. Appendiceal actinomycosis mimicking appendiceal tumor, appendicitis or inflammatory bowel disease. J Pathol Transl Med 2020; 55:349-354. [PMID: 32580538 PMCID: PMC8476320 DOI: 10.4132/jptm.2020.05.17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 05/17/2020] [Indexed: 11/18/2022] Open
Abstract
Appendiceal actinomycosis is very rare and its diagnosis is often difficult even in surgically resected specimens. Here we report two cases of appendiceal actinomycosis confirmed by pathologic examination of surgically resected specimens. Characteristic histologic features included transmural chronic inflammation with Crohn-like lymphoid aggregates and polypoid mucosal protrusion into cecal lumen through fibrous expansion of the submucosa. Chronic active inflammation involved the mucosa of the appendix and cecum around the appendiceal orifice. Crohn’s disease with predominant cecal involvement and inflammatory pseudotumor were considered as differential diagnoses. Careful examination revealed a few actinomycotic colonies in the mucosa, confirming the diagnosis. A high index of suspicion with awareness of the characteristic histologic features might prompt careful inspection for the actinomycotic colonies, leading to the appropriate diagnosis of this rare disease.
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Affiliation(s)
- You-Na Sung
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jihun Kim
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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13
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Nail Biting as a Cause of Appendicitis. Case Rep Surg 2020; 2020:3930905. [PMID: 32309003 PMCID: PMC7152951 DOI: 10.1155/2020/3930905] [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: 01/03/2020] [Accepted: 02/25/2020] [Indexed: 12/02/2022] Open
Abstract
Ingestion of a foreign body is commonly encountered in clinical practice, but most cause no complications, passing spontaneously through the gastrointestinal tract. However, they can cause obstructive signs and symptoms, and surgical intervention for extraction of the foreign body may be required after identifying its location. We present here the case of a 49-year-old woman who presented to our emergency room with abdominal pain localizing to the right lower quadrant. Evaluation was most consistent with acute appendicitis, and she underwent uncomplicated appendectomy. A keratin nail with Actinomyces was identified in her appendix. Foreign bodies in the appendix can cause simple appendicitis, perforation, periappendiceal abscess, and peritonitis. Regardless of etiology, an appendectomy often ends up the primary treatment, but unusual and rare causes are worth noting if only for the clinician to be aware of when evaluating the next patient with abdominal pain and considering treatment options or future prevention. Our case is an example of a rare scenario in which an Actinomyces-contaminated human nail lodged in the appendix of a woman eventually resulting in acute appendicitis.
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14
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Balakrishnan M, Phan YC, McIlroy B, Leung E. "Fungating" tumour? No, it's bacterial! BMJ Case Rep 2019; 12:12/2/e227876. [PMID: 30804160 DOI: 10.1136/bcr-2018-227876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A fit and healthy 26-year-old woman presented to the general surgical team with epigastric pain and weight loss of 2 stones over 6 months. She has also a positive family history of ulcerative colitis. As her oesophagogastroduodenoscopy and colonoscopy were normal, a contrasted CT was requested, and it detected an inflammatory mass with fat streaking around her transverse colon. An intrauterine contraceptive device (IUCD) was noted. In light of the CT findings, she underwent a diagnostic laparoscopy. As the inflammatory mass was not separable from the transverse colon, a segmental transverse colectomy was proceeded. The histology revealed multiple actinomycosis abscesses in the mesentery. Subsequently, we learnt that her IUCD had been in situ for the last 7 years, and the source of actinomycosis abscesses is likely from her IUCD. The patient was recommended to have the coil removed and commenced on a 6 months course of amoxicillin.
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Affiliation(s)
| | - Yih Chyn Phan
- County Hospital Hereford, Hereford, UK.,College of Medicine and Veterinary Medicine, Edinburgh Medical school, The University of Edinburgh, Edinburgh, UK
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Atalaia-Martins C, Cotrim I, Alves P. Appendiceal Tumor or Something More? Gastroenterology 2018; 154:e14-e15. [PMID: 28989065 DOI: 10.1053/j.gastro.2017.09.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 09/13/2017] [Accepted: 09/15/2017] [Indexed: 12/02/2022]
Affiliation(s)
| | - Isabel Cotrim
- Surgery Department, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Paulo Alves
- Surgery Department, Centro Hospitalar de Leiria, Leiria, Portugal
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