Abdominal actinomycosis: Barium enema and computed tomography findings

Abstract

A case of abdominal actinomycosis is described in a woman with recurrent right lower abdominal pain and low-grade fever without history of appendectomy. Past history included the use of an intrauterine device (IUD) until 10 years before manifestation of these symptoms. We followed up the patient, via diagnostic imaging, for 7 months. On initial barium enema, a polypoid lesion was visualized at the bottom of the cecum and there was constriction of the sigmoid colon; the appendix was not seen. Seven months later, poor extension at the cecum, severe constriction in the sigmoid colon, and narrowing of the terminal ileum were also visualized. On computed tomography (CT), the lesion was initially localized only in the ileocecal region adjacent to the sigmoid colon. After 7 months, the lesion had infiltrated adjacent anatomic components and showed direct infiltration of the pelvic space. Differential diagnosis was difficult, as it was not obvious whether this was a pelvic abscess due to inflammation or appendiceal carcinoma. Laparotomy was performed. Macroscopically, the lesion was not limited to the ileocecal region, but involved the right ureter, tubes the Fallopian and ovary, bladder, psoas muscle, and abdominal wall. Pathology findings showed, chronic inflammatory tissue with evidence of actinomycosis. Although previous reports have described a lack of specific findings in this disease. When actinomycosis is suspected, CT is recommended to define its extent.

Clinical Features of Abdominopelvic Actinomycosis: Report of Twenty Cases and Literature Review

“…Humans are natural reservoirs and there is no documented person-to-person transmission of the disease, and it is commonly cultured from carious teeth, tonsilar crypts 2. It is characterized by a tendency to feign malignancy due to its capacity to invade surrounding tissues and to form masses 3.…”

Clinical Features of Abdominal Actinomycosis: A 15-year Experience of A Single Institute

“…And it exists in the normal flora of the oral cavity, throughout the gastrointestinal tract and the female genital tract (1). It is also commonly cultured from carious teeth and tonsila crypts (9, 10). This infection usually spreads locally in an indolent manner, and it may take months to years before any symptoms manifest (11).…”

Computed tomography for the preoperative diagnosis of pelvic actinomycosis

“…Abdominal CT scan seems to be useful to define the extent of lesions and extramucosal involvement 13,14 . Uchiyama et al .…”

“…Abdominal CT scan seems to be useful to define the extent of lesions and extramucosal involvement. 13,14 Uchiyama et al recommended CT scans for estimating the extent of disease when actinomycosis is suspected. 13 In this study, pelvic actinomycosis was suspected preoperatively in eight patients, and CT scan appeared to aid the correct diagnosis.…”