Surgical treatment for abdominal actinomycosis: A report of two cases

Abstract

Since actinomycosis sometimes causes an abdominal tumor which mimics malignancy, treatment strategy varies from case to case. We herein report two cases which were treated with a combination of antibiotics and surgical intervention. Both patients presented with an intra-abdominal tumor lesion mimicking malignant disease after an appendectomy for acute appendicitis. Case 1 received surgical extirpation of the abdominal tumor in the liver and kidney twice since the clinical diagnosis of actinomycosis was not made. In contrast, case 2 was successfully treated by a combination of antibiotics and laparoscopic surgery following the experience of case 1. When a high probability diagnosis can be made, a laparoscopic approach is a useful and effective option to treat this condition.

Abdominal Actinomycosis: A Case Report

“…The main abdominopelvic actinomycosis usually imitates an intra-abdominal tumor or malignancy because of its capacity to establish a mass infiltrated while postoperative actinomycosis occurs more frequently as abscess [7]. Our patient was considered with a skin fistula with peritoneal mass, while it might be a single abscess of the liver, mimics an inflammatory bowel disease or pelvic abscess [4,8]. Similar to our case, other cases of actinomycosis commonly do not cause signs or symptoms of the characteristic disease and generally manifests itself as a slow-growing mass, which can be related to vomiting, nausea, altered bowel habit changes and pain [6]; causes preoperative diagnosis mistake and is found in only less than 10% of cases and histopathological examination in other cases is the most used diagnostic methods after an operation [6].…”

“…Actinomyces is usually considered a saprophyte in the gastrointestinal tract, and genital tract, including mechanical wounds, operations, intrauterine contraceptive device placement and tooth extraction can totally destroy the mucosal barrier structure, which makes it easier for the pathogen to penetrate deeper into the tissue [4]. Our case predisposing variables are the history of appendectomy and currtage, although 50 % of patients have no predisposing factor [5].…”

Abdominal Actinomycosis—an Interesting Case

“…Actinomyces is considered to be a saprophyte in the oral cavity, gastrointestinal tract and the female genital tract. Some surgical triggers such as mechanical wounds due to tooth pick or fish bones, operation, placement of intrauterine contraceptive device and teeth extraction may act to destroy the mucosal barrier function, resulting in facilitation of invasion of the pathogen into deeper tissue from its original habitat [4].…”

Actinomycosis mimicking colonic neoplasia

“…However, this fact does not reduce the importance of a preoperative diagnosis, because the treatment with antiobiotics prior to surgery can decrease the size of the lesion and enable a less extensive resection 18 . Besides, with a previous diagnosis of actinomycosis, resection does not need to meet oncologic criteria.…”