Abstract
Pelvic actinomycosis is a rare disease that can result in abscess formation, bowel obstruction, and other serious complications. Moreover, the correct diagnosis can seldom be established before radical surgery because the disease often mimics pelvic neoplasms. It has been recently recognized that pelvic actinomycosis is associated with long-term use of an intrauterine contraceptive device.We report a woman with a long-standing intrauterine contraceptive device who visited our hospital complaining of symptoms mimicking large bowel ileus with a subacute course. X-ray fluorography and sigmoidoscopy showed marked stenosis in the sigmoid colon but rejected the possibility of colon cancers. Abdomino-pelvic CT and MRI revealed a huge abscess lying over the urinary bladder and anterior to the uterus. Furthermore, a cervical Papanicolaou smear disclosed Actinomyces species. We removed the intrauterine device from the patient. Subsequent high-dose ampicillin administration led to dramatic shrinkage of the abscess and improved the management of the bowel movement quickly. This is a successful case of symptomatic pelvic actinomycosis that was correctly diagnosed and treated without unnecessary surgical intervention.
Highlights
A 51-year-old woman, gravida 2, para 2, visited a local clinic and presented with constipation, worsening abdominal cramps, nausea and increased abdominal girth for a month
Subsequent high-dose ampicillin administration led to dramatic shrinkage of the abscess and improved the management of the bowel movement quickly. This is a successful case of symptomatic pelvic actinomycosis that was correctly diagnosed and treated without unnecessary surgical intervention
She was initially diagnosed with enterocolitis, but became progressively more constipated. She was referred to our hospital for further examinations, having received fosfomycin for the previous 4 days aimed at alleviating her elevated white blood cell (WBC) count (12,700/μl) with a raised C-reactive protein (CRP) level of 11.3 mg/dl
Summary
Actinomyces is a slow-growing, filamentous, gram-positive anaerobe. Traditionally actinomycosis of the female genital tract has been thought to originate from ascending infection of the bacteria by oro- or anogenital contact or by a pessary. Unlike mass-forming actinomycosis, we observed that the wall of abscess-forming actinomycosis was of intermediate to high signal intensity on T2-weighted MR images These image findings of actinomycosis appear non-specific [5] and are dependent on the involved regions and degree of inflammation [7]. Together with the clinical symptoms, the images often simulate those of gastrointestinal and gynecological malignancies [3,4] These reasons render the disease undiagnosable, and 83% of cases undergo major surgical operation such as hysterectomy, salpingo-oophoerectomy, bowel resection, drainage of abscess, etc [3,7]. Our patient manifested severe gastrointestinal symptoms and an abscess close to 8 cm in diameter, we explored the opportunity to avoid unnecessary drainage She responded to the conservative therapy rapidly and http://www.jmedicalcasereports.com/content/1/1/141 remarkably, which was confirmed by follow-up laboratory tests and MRI
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