Abdominal Actinomycosis Mimicking Colon Cancer

Abstract

RezumatIntroducere: Actinomicoza abdominală este o afecţiune inflamatorie granulomatoasă rară produsă de o bacterie anaerobă Gram pozitivă Actinomyces israelii, care se manifestă ca tumori inflamatorii sau formează abcese. Evoluţia este lentã şi constã în extensie inflamatorie de contiguitate, fãrã limitã de organ, ce pretează la confuzia cu leziuni maligne abdominale. Material şi metodă: Am efectuat un studiu retrospectiv a pacienţilor cu actinomicoză abdominală operaţi în Clinica I Chirurgie Spitalul Universitar " Sf. Spiridon" din Iaşi, între 1980 şi 2018. Au fost înregistrate 13 cazuri (4 bărbaţi şi 9 femei) cu vârsta medie de 44,07 ani care s-au internat cu tumori abdominale (7 cazuri) şi boala inflamatorie pelvină (6 cazuri). Rezultate: Am identificat ca factori predispozanţi: dispositive intrauterine menţinute timp de 10 ani (6 cazuri), corpuri străine -2 cazuri (o scobitoare de lemn care probabil a perforat colonul, calculi biliari pierdut în peritoneu), diabet (3 cazuri), imunodepresia. Pacienţii au fost operaţi prin laparotomie (9 cazuri) sau laparoscopic (4 cazuri). Descriem cinci dintre aceste cazuri de actinomicoză care au mimat un cancer de colon: localizare ileo -cecală -3 cazuri, colon transvers -un caz şi mare epiploon -un caz, care au urmat tratament specific cu penicilină, având o evoluţie bună. Concluzii: Actinomicoza abdominală trebuie întotdeauna inclusă în diagnosticul diferenţial al tumorilor abdominale. Diagnosticul preoperator, dificil, dar posibil, poate evita intervenţia chirurgicală. Tratamentul cu antibiotice este necesar pentru vindecarea bolii. Controlul postoperator este obligatoriu, cu recidive posibile. AbstractIntroduction: Abdominal actinomycosis is a rare granulomatous inflammatory disease caused by a Gram-positive anaerobic bacterium Actinomyces israelii, manifesting as inflammatory mass, or abscess formation. Evolution is slow and steady in inflammatory contiguous extension without limit organ that lends itself to confusion with abdominal malignancies. Methods: We performed a retrospective study on the patients with abdominal actinomycosis operated in the First Surgical Clinic, "St. Spiridon" University Hospital Iasi; between 1980 -2018 there have been 13 cases (4 men and 9 women) with a mean age 44.07 years admitted for abdominal tumors (7 cases) or pelvic inflammatory disease (6 cases). Results: We identified as predisposing factors: IUD maintained over 10 years (6 cases), foreign bodies -2 cases (a toothpick probably perforated colon, gallstones lost in peritoneum), diabetes (3 cases), immunodepression. All cases were operated by laparotomy (9 cases) or laparoscopic approach (4 cases). We describe five of these cases of actinomycosis that had been mimicking a colon cancer: ileo -cecal -3 cases, transverse colon -one case and on the greater omentum -one case, followed by specific treatment with penicillin, with good evolution. Conclusions: Abdominal actinomycosis should always be included in the differential diagnosis of abdominal tumors. Preoperative diagnosis, difficult...

Abdominal Actinomycosis misdiagnosed as liposarcoma

“…9 Actinomyces infection involves the abdomen in up to 20% of the cases, and has been called "the great imitator". 4,5,7,[10][11][12] The most frequently affected gastrointestinal sites are the appendix, cecum, and colon, but any part of the gastrointestinal tract can be involved. [4][5][6] The disease is distributed worldwide, involves all ages, and males seem to be more frequently affected than females, at a ratio of 3:1.…”

“…4,5,7,[10][11][12] The most frequently affected gastrointestinal sites are the appendix, cecum, and colon, but any part of the gastrointestinal tract can be involved. [4][5][6] The disease is distributed worldwide, involves all ages, and males seem to be more frequently affected than females, at a ratio of 3:1. 5,8 Currently, Abdominal actinomycosis (AA) is a challenging diagnosis as it is a rare disease with a varying and nonspecific clinical presentation that may mimic other more common entities such as colorectal carcinoma or other malignant tumors, Crohn's disease, appendicitis, diverticulitis, ulcerative colitis, pelvic inflammatory disease and intestinal tuberculosis.…”

“…5,8 Currently, Abdominal actinomycosis (AA) is a challenging diagnosis as it is a rare disease with a varying and nonspecific clinical presentation that may mimic other more common entities such as colorectal carcinoma or other malignant tumors, Crohn's disease, appendicitis, diverticulitis, ulcerative colitis, pelvic inflammatory disease and intestinal tuberculosis. 4,6,7 The diagnosis of AA is frequently made in surgical specimens, when surgery is undertaken in the pursuit of neoplasia or appendicitis. Less than 10% of the cases are diagnosed before surgery.…”

“…[4][5][6][7][8] The local tissue damage caused by trauma, recent surgery, irradiation, and loss of mucosal integrity by foreign bodies, perforated appendix or diverticulitis, neoplasia is recognized as predisposing factors. 4,5,[7][8][9][10] However, cases were reported without any preceding mucosal injury. 11 Some authors suggest that inflammatory or malignant processes may contribute to the development of actinomycosis.…”

“…11 Some authors suggest that inflammatory or malignant processes may contribute to the development of actinomycosis. 4,7 Actinomycosis usually spreads locally in an indolent manner and may take months to years before the first symptoms appear. 7,9,10…”