Abdominal actinomycosis: a rare complication after cholecystectomy

Area of Science:

• Medical Microbiology
• Infectious Diseases
• Surgical Pathology

Background:

• Abdominal actinomycosis is a rare, chronic granulomatous infection caused by Actinomyces species.
• Characterized by the presence of 'sulphur granules', it often occurs in patients with a history of surgical or invasive procedures.
• It presents a diagnostic challenge, frequently mimicking other abdominal pathologies.

Purpose of the Study:

• To report a case of abdominal actinomycosis in a patient with a history of cholecystectomy.
• To review the literature regarding risk factors, clinical presentation, diagnostic methods, and treatment of abdominal actinomycosis.
• To emphasize the importance of considering Actinomyces in the differential diagnosis of abdominal masses.

Main Methods:

• Case presentation of a 74-year-old female with abdominal actinomycosis.
• Literature review focusing on risk factors, clinical characteristics, diagnosis, and treatment.
• Discussion of diagnostic modalities, including computed tomography (CT)-guided aspiration and biopsy.
• Histochemical, macroscopic, and microscopic examination of tissue specimens for definitive diagnosis.

Main Results:

• The case highlights the occurrence of abdominal actinomycosis in a patient with prior cholecystectomy.
• Diagnosis is often delayed, with less than 10% of cases identified pre-operatively.
• Definitive diagnosis relies on histopathological examination of tissue.
• Effective treatment involves high-dose intravenous penicillin followed by long-term oral therapy.

Conclusions:

• Actinomyces species should be considered in the differential diagnosis of abdominal masses, especially in patients with a history of surgery.
• CT-guided aspiration or biopsy is a valuable diagnostic tool.
• A prolonged course of penicillin is the mainstay of treatment for abdominal actinomycosis.