Actinomycosis complicating sigmoid diverticular disease: a case report

Abstract

A 63-year-old Caucasian woman was admitted to hospital as hypotensive with abdominal tenderness and vaginal discharge. Laboratory investigations showed microcytic anaemia, low albumin and high white cell count. Computerised tomography scans revealed small bowel dilatation, sigmoid diverticula, ascites and pelvic fluid. The endometrial pipelle was positive and vaginal swab was negative for actinomyces. Post mortem examination revealed widespread sigmoid diverticular disease and bowel perforation with an intense inflammation. Actinomycotic granules were noted in the diverticular inflammatory debris, pelvic abscess and lung sections. Clinical course and histomorphological findings favour the perforating sigmoid diverticular actinomycosis as an origin of the systemic infection.

Abdominal actinomycosis masquerading as colon cancer in a liver transplant recipient

“…Abdominal actinomycosis may also present as an abscess, with or without the development of sinus tracts that drain into the abdominal wall or perianal region . Right‐sided abdominal infection is more common than left‐sided, and the most common provocative events are appendicitis and diverticulitis . Bowel surgery, intraluminal foreign bodies, inflammatory bowel disease, typhoid fever, and peptic ulcers may also precede the infection .…”

“…Radiologic signs are also not specific. CT may reveal a mass with an invasive pattern mimicking a tumor with involvement of multiple compartments, together with extrinsic compression, luminal narrowing, bowel wall inflammation (when there is colonic involvement), fistulization, and rarely, complete obstruction . In a study of 8 patients with abdominal actinomycosis by Kim et al.…”