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Pelvic actinomycosis masquerading as an acute abdomen from a small bowel perforation

K Devendra1, C M Chen

  • 1Department of Obstetrics and Gynaecology, Singapore General Hospital, Outram Road, Singapore 169608. devendra.kanagalingam@sgh.com.sg

Singapore Medical Journal
|February 28, 2008
PubMed

Insights

Pelvic actinomycosis, a rare complication of long-term intrauterine contraceptive device (IUCD) use, can mimic other abdominal conditions. Early diagnosis is crucial to avoid unnecessary surgery for this serious infection.

Area of Science:

  • Gynecology
  • Infectious Diseases
  • Surgical Pathology

Background:

  • Pelvic actinomycosis is an uncommon condition associated with intrauterine contraceptive device (IUCD) usage.
  • Early diagnosis is critical as symptoms can mimic other intra-abdominal pathologies, potentially leading to unwarranted surgical interventions.

Observation:

  • A 50-year-old woman presented with symptoms suggestive of acute peritonitis.
  • She had a neglected intrauterine device (IUD) in situ for 20 years.
  • Intraoperative findings suggested a perforated small bowel segment.

Findings:

  • The patient underwent small bowel resection.
  • Histopathological examination of the surgical specimen confirmed pelvic actinomycosis.
  • The diagnosis was established postoperatively, highlighting diagnostic challenges.

Implications:

  • A high index of suspicion for pelvic actinomycosis is necessary in women with an IUCD presenting with acute abdominal symptoms.
  • Regular replacement of IUCDs and adherence to "missing threads" protocols are vital preventive measures.
  • Timely recognition and management can prevent severe complications and unnecessary surgeries.

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