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[Abdomino-pelvic actinomycosis. Report of 2 cases]
Neziha Belkahla1, Slimene Ourak, Hajer Ouerghi
1Service de Gastro-entérologie B, Hôpital La Rabta.
Abstract:
Actinomycosis is a chronic, granulomatous, suppurative and fistulasing infection related to a gram-positive bacteria (actinomyces israeli). Cervico-facial actinomycosis is the most common localization. The prevalence of abdomino-pelvic actinomycosis is increasing mainly with the increase of the use of intrauterin device. Its clinical presentation is variable and may mimic cancer or tuberculosis. The diagnosis of abdomino-pelvic actinomycosis is hard and most of the cases are detected during surgical exploration. We report two cases of abdomino-pelvic actinomycosis; in the first case, the disease was extended to the caecum and the abdominal wall. The skin biopsies made the diagnosis of actinomycosis, avoiding surgery. In the second case, the diagnosis of actinomycosis is made post operatively because of high suspicion of pelvic cancer. Through these two observations, we review pathogenesis of the disease, its clinical aspects and its diagnostic and therapeutic means.
Insights
Abdomino-pelvic actinomycosis, a bacterial infection, presents variably and can mimic cancer. Early diagnosis through methods like skin biopsies is crucial for effective treatment and avoiding unnecessary surgery.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Surgical Pathology
Background:
- Actinomycosis is a chronic bacterial infection caused by gram-positive Actinomyces israeli.
- Cervico-facial actinomycosis is the most common form, but abdomino-pelvic cases are increasing, particularly with intrauterine device use.
- Abdomino-pelvic actinomycosis presents with diverse symptoms, often mimicking malignancy or tuberculosis, complicating diagnosis.
Observation:
- Two cases of abdomino-pelvic actinomycosis are presented.
- The first case involved extension to the cecum and abdominal wall, with diagnosis achieved via skin biopsies, averting surgery.
- The second case was diagnosed post-operatively due to suspicion of pelvic cancer.
Findings:
- Skin biopsies can be instrumental in diagnosing actinomycosis, potentially avoiding invasive surgical exploration.
- High clinical suspicion is necessary for diagnosing abdomino-pelvic actinomycosis, as it can present insidiously.
- Diagnostic challenges underscore the need for awareness of actinomycosis in differential diagnoses for abdominal and pelvic masses.
Implications:
- This review highlights the importance of considering actinomycosis in the differential diagnosis of abdomino-pelvic conditions.
- Non-invasive diagnostic methods like skin biopsy should be explored to facilitate earlier and more accurate diagnosis.
- Understanding the pathogenesis, clinical spectrum, and diagnostic/therapeutic options is vital for managing this challenging infection.
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