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Abdominal actinomycosis
J R Cintron1, A Del Pino, B Duarte
1Department of Surgery, The West Side Veterans Administration Hospital and Medical Center, Chicago, Illinois 60612, USA.
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.
Insights
Abdominal actinomycosis, a rare infection, can mimic cancer. Diagnosis is challenging, but computed tomography and needle aspiration can guide non-surgical treatment with penicillin, avoiding extensive surgery.
Area of Science:
- Medical Microbiology
- Surgical Pathology
- Diagnostic Imaging
Background:
- Actinomyces israelii, a commensal bacterium, rarely causes disease.
- Abdominal actinomycosis presents as masses or abscesses, often mistaken for malignancy.
- Preoperative diagnosis is difficult, frequently necessitating surgical exploration.
Observation:
- Two cases of abdominal actinomycosis are presented, involving the sigmoid colon and retroperitoneum.
- Both cases simulated malignant neoplasms, requiring surgical intervention for diagnosis and treatment.
- Actinomycotic masses and strictures can present diagnostic challenges, mimicking other pathologies.
Findings:
- Long-term penicillin treatment is effective for actinomycotic abdominal masses and strictures.
- Successful non-surgical management is achievable, obviating the need for surgical resection.
- Definitive preoperative diagnosis remains a significant challenge in managing actinomycosis.
Implications:
- Computed tomography (CT) is the most valuable diagnostic tool for abdominal actinomycosis.
- Abdominal actinomycosis typically appears as a contrast-enhancing, multicystic lesion on CT scans.
- Needle aspiration cytology offers a reliable method for diagnosing suspicious lesions, guiding conservative treatment.