Abdominal actinomycosis--a late complication of gastrectomy

A patient with abdominal actinomycosis, two years after gastrectomy, is reported. First suspicion of this diagnosis was aroused by fistula formation in the abdominal wall. The correct diagnosis was only established by Gram-staining. Treatment with high doses of penicillin resulted in rapid and complete recovery. This is one of the most misdiagnosed diseases because of its variety of clinical presentation. This case is reported to emphasize the rare occurrence and the difficulty in making an early diagnosis. The diagnosis of abdominal actinomycosis should be considered in any patient in whom persistent or unusual cutaneous fistulas develop after surgical procedures on the gastrointestinal tract.