Abdominal actinomycosis

Dis Colon Rectum. 1996 Jan;39(1):105-8. doi: 10.1007/BF02048278.

Abstract

Purpose: Actinomyces israelii are normal inhabitants in the oral cavity and upper intestinal tract of humans. They rarely cause disease and are seldom reported as pathogens. As a pathogen it causes fistulas, sinuses, and may appear as an abdominal mass and/or abscess. The abdominal mass can masquerade as a malignant process that is very difficult to differentiate, often requiring surgical intervention with resection. Because of difficulty in making a preoperative diagnosis, we undertook this review to determine if all patients require surgical intervention and whether other adjunctive modalities may improve preoperative diagnosis.

Methods: We report two patients with abdominal actinomycosis, one affecting the sigmoid colon and the other the retroperitoneum, iliac crest region. Both simulated a malignant process and required operations for diagnosis and treatment.

Results: As reported, actinomycotic abdominal masses and strictures can be treated by penicillin alone. Long-term medical treatment seems to be very successful and avoids surgical resection. The difficulty is obtaining a definitive diagnosis.

Conclusion: The computed tomographic scan is the most helpful diagnostic modality. Appearance of abdominal actinomycosis is usually a contrast enhancing multicystic lesion as was found in these two patients. Needle aspiration cytology can be fairly accurate in obtaining the diagnosis and is recommended for suspicious lesions.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Abdominal Abscess / diagnosis*
  • Abdominal Abscess / microbiology
  • Abdominal Abscess / surgery*
  • Actinomycosis / diagnosis*
  • Actinomycosis / surgery*
  • Adult
  • Biopsy, Needle
  • Diagnosis, Differential
  • Humans
  • Male
  • Middle Aged
  • Retroperitoneal Space
  • Sigmoid Diseases / diagnosis*
  • Sigmoid Diseases / microbiology
  • Sigmoid Diseases / surgery*
  • Tomography, X-Ray Computed