Primary actinomycosis of the urachus

Ovarian and vesical actinomycosis: a case report and literature review

We present a patient with a tubo-ovarian abscess pathologically confirmed to be actinomycosis in a 44-year-old woman with an intrauterine device (IUD). An ultrasound showed that the IUD was imposed on an apparently degenerated myoma. A pelvic MRI was performed to differentiate the uterine findings from a sarcoma. The MRI showed a heterogeneous pelvic mass and a bladder mass suggesting chronic inflammation caused by an organism such as actinomycosis. An exploratory laparotomy was performed, which revealed a right tubo-ovarian mass with abscess formation as well as a bladder mass. A subtotal hysterectomy, right salpingoophorectomy, partial cystectomy, and appendectomy were performed in addition to drainage of the abscess. Histopathological examination revealed a tubo-ovarian abscess and a bladder mass with colonies of actinomycoses.

Primary vesical actinomycosis: a case report and literature review

Pelvic actinomycosis is a chronic granulomatous infection caused by the gram-positive anaerobic bacteria, Actinomyces Israelli. Vesical lesions, particularly without any obvious source of infection, are rare. We report a case of primary vesical actinomycosis which presented as a bladder mass, giving suspicion of malignancy. Repeated trans-urethral deep resections and histo-pathological examinations revealed the true nature of the mass, which was treated by medical means. A high index of suspicion of potentially benign bladder lesions, particularly in a younger age group of patients, is advocated, to prevent unnecessary major surgical procedures.

Intramural bladder-wall abscess: a late complication arising after a urethrocystoscopy?

Intramural bladder-wall abscesses are serious but rather rare. In the few reported cases, their aetiology has not been explicitly explained. In our case, we found a traumatic outcome induced by a urethrocystoscopy that had taken place 4 years prior to the diagnosis of abscess. To date, there has not been much published on these bladder-wall abscesses or urinary tract infections from urethrocystoscopies and Burkholderia cepacia bacteria. As a result, their pathogenesis and aetiology have not been fully explained. In this paper we report on the clinical as well as the subjective well-being of a female child who was diagnosed with a massive full-blown intramural bladder-wall abscess that developed 4 years after she had undergone a urethrocystoscopy.

Pelvic actinomycosis: urologic perspective

PURPOSE

Actinomycosis is a chronic granulomatous infection caused by the gram-positive anaerobic bacteria, Actinomyces israelli. This paper reviews the etiology and clinical presentation associated with Actinomycosis that often presents as a pelvic mass that mimics a pelvic malignancy.

MATERIALS AND METHODS

A combination of patients treated by the authors in the recent past and a literature review of patients with pelvic Actinomycosis were assessed for demographic, clinical and predisposing co-factors. An analysis is made of age distribution, gender, diagnostic methods and treatment concepts.

RESULTS

Thirty-three patients were included in the study that included 2 current patients and 31 obtained from literature review. There were 27 females (age range 16 - 69 years, mean 38 years) and 6 males (16 - 55 years, mean 36 years). Presenting signs and symptoms were lower abdominal mass in 28 (85%); lower abdominal pain in 21 (63%); vaginal discharge or hematuria in 7 (22%). Two patients developed fistulae (entero-vesico 1; vesico-cutaneous 1). Nineteen (70%) of the 27 female patients had intra-uterine contraceptive devices (IUD). Four patients (12.5%) (3 males and 1 female) had urachus or urachal remnants. Cystoscopy in 12 patients noted an extrinsic mass effect, bullous edema and in one patient " vegetative proliferation " proven to be a chronic inflammatory change. Exploratory laparotomy was performed in 32 of the 33 patients who had excision of mass and involved organs. Diagnosis was established by histologic examination of removed tissue. Penicillin (6 weeks) therapy was utilized to control infections.

CONCLUSION

Pelvic actinomycosis mimics pelvic malignancy and may be associated with the long-term use of intra-uterine contraceptive devices, and persistent urachal remnants. Removal of infected mass and antibiotic therapy will eradicate the inflammatory process.

Primary actinomycosis mimicking urachal carcinoma

We report a case of urachal actinomycosis that presented with a progressively enlarging infraumbilical mass associated with umbilical discharge. Computed tomography revealed an extraperitoneal mass involving the dome of the bladder. The possible diagnosis included a malignant urachal neoplasm or chronic inflammatory mass. Partial cystectomy and excision of the mass was performed. The pathologic examination revealed actinomycosis. The patient was treated with a 6-month course of antibiotics. No recurrence was noted 1 year postoperatively.