“Fungating” tumour? No, it’s bacterial!

Abstract

A fit and healthy 26-year-old woman presented to the general surgical team with epigastric pain and weight loss of 2 stones over 6 months. She has also a positive family history of ulcerative colitis. As her oesophagogastroduodenoscopy and colonoscopy were normal, a contrasted CT was requested, and it detected an inflammatory mass with fat streaking around her transverse colon. An intrauterine contraceptive device (IUCD) was noted. In light of the CT findings, she underwent a diagnostic laparoscopy. As the inflammatory mass was not separable from the transverse colon, a segmental transverse colectomy was proceeded. The histology revealed multiple actinomycosis abscesses in the mesentery. Subsequently, we learnt that her IUCD had been in situ for the last 7 years, and the source of actinomycosis abscesses is likely from her IUCD. The patient was recommended to have the coil removed and commenced on a 6 months course of amoxicillin.

Two case reports of mesenteric and retroperitoneal actinomycosis and a narrative review of the relevant literature

“…Renal, gallbladder and biliary tract [23], pancreas, stomach, small intestine, and omental actinomycosis cases have also been reported [24][25][26]. Mesenteric actinomycosis is extremely rare, with very few reports in the literature, and usually presents as a mesenchymal mesenteric tumor with non-specific characteristics [4]. Chan et al described the case of a 45-year-old man with abdominal pain, whose CT image revealed a mesentery-limited actinomycotic abscess without extension to surrounding tissue, except for the accompanying inflammation of the appendiceal tip [20].…”

“…Depending on the body system affected, actinomycosis can be classified as oro-cervico-facial, thoracic or abdominopelvic disease. The involvement of other body regions leads to symptoms from the central nervous system (CNS), the cardiovascular system, the musculoskeletal system, the urinary system, and the skin [ 3 , 4 ]. Lately, a decreasing incidence of the oro-cervico-facial type of actinomycosis has been reported, whereas abdominal and pelvic infections are increasing, mainly due to the use of intrauterine contraceptive devices (IUCD) [ 5 ].…”