Abdominopelvic Actinomycosis—The Diagnostic and Therapeutic Challenge of the Most Misdiagnosed Disease

Abstract

Abdominopelvic actinomycosis is a rare chronic or subacute bacterial infection caused by Actinomyces israelii, a Gram-positive anaerobic bacterium that normally colonizes the digestive and genital tracts, clinically presented as an inflammatory mass or abscess formation. Methods: We reviewed the medical records of the patients from our clinic with abdominopelvic actinomycosis who underwent surgery between 2002 and 2022. In this period, 28 cases (9 men and 19 women) were treated. The mean age was 43.36 years and they were hospitalized for abdominopelvic tumors or inflammatory tumors in 15 cases and inflammatory disease in 13 cases. Results: Causes of actinomycosis in the studied group were an intra-uterine contraceptive device in 17 cases, foreign bodies in 2 cases, diabetes in 4 cases, stenting of the bile duct in 1 case, and immunodepression. For 6 patients, we performed surgery by open approach and for 21 patients by a laparoscopic approach. For nine patients, abdominopelvic actinomycosis had been mimicking a colon malignancy (cecum and ascending colon, four cases; transverse colon, two cases; and on the greater omentum, three cases) and for six patients, a pelvic tumor (advanced ovarian cancer). After surgery the patients underwent specific treatment with antibiotics, with good results. In two cases we discovered and treated hepatic actinomycosis, one case by a laparoscopic approach and one case by a percutaneous approach. In our lot we noticed three recurrences that required reintervention in patients who had had short-term antibiotics due to non-compliance with treatment out of four such cases. Conclusions: For abdominopelvic malignancies, actinomycosis should be included in the differential diagnosis, as well as for inflammatory bowel diseases and bowel obstructions. We have a wide range of patients considering the rarity of this condition. Long-term antibiotics are necessary to prevent recurrence.

Pseudo tumor pelvic actinomycosis revealed by colonic obstruction with hydronephrosis: Can extensive surgery be avoided? A case report

“…The colonization rate increases with the duration of its maintenance. 2 , 5 Vasilesco et al 6 reviewed the medical records of 28 patients with abdominopelvic actinomycosis (9 men and 19 women) and the cause of actinomycosis in the studied group was an IUD device in 17 cases from which, 6 patients were admitted because they mimicked a complicated abdominopelvic malignant ovarian advanced ovarian cancer. To reduce the occurrence of this affection, it is recommended that IUDs be changed periodically, every 3–5 years.…”

Case report: Colonic actinomycosis – A rare cause of a locally advanced colonic tumour

“…Further delineation from malignancy maybe done by careful evaluation of cross-sectional imaging. Firstly, due to the size of the bacterium it does not easily spread via lymphatics [14] . Therefore, although the infiltrative nature of these infections closely mimic neoplasms on CT, the paucity of lymphadenopathy despite the significant “tumour” burden is characteristic of actinomycosis [14] , [15] .…”

“…Firstly, due to the size of the bacterium it does not easily spread via lymphatics [14] . Therefore, although the infiltrative nature of these infections closely mimic neoplasms on CT, the paucity of lymphadenopathy despite the significant “tumour” burden is characteristic of actinomycosis [14] , [15] . Notably, in the index case only 15 nodes were retrieved despite the extent of en block resection.…”

Disseminated Intra-abdominal Actinomycosis Mimicking Colorectal Carcinoma With Diffuse Intra-abdominal Carcinomatosis: A Case Report

“…Having diabetes mellitus increases a patient’s risk of contracting gastrointestinal infections [ 8 ]. According to retrospective studies conducted among 41 patients with abdominal actinomycosis, seven cases showed an association with diabetes [ 4 , 5 ].…”

“…In addition, clinical pictures and imaging modalities are not always adequate in differentiating malignancy from inflammatory conditions for a variety of reasons, leading to a 10% lower rate of presurgical diagnosis [ 1 ]. In the literature from 2002 to 2022, twenty-eight cases were reported with abdominal actinomyces in patients who underwent surgery, with only two cases that have received a preoperative diagnosis [ 4 ]. Another literature review from 1980 to 2018 showed thirteen cases that have been postoperatively diagnosed after histopathological and microbiological assessment [ 5 ].…”