Thrombocytosis and small bowel perforation: unusual presentation of abdominopelvic actinomycosis

Güldeniz Desteli ,Funda Timurkaynak,Türkan Gürsu ,Ebru Kızılkılıç ,Ebru Demıralay ,Hüseyin Yüce Bircan

doi:10.3855/jidc.2837

Güldeniz Desteli , Funda Timurkaynak + Show 4 more

Open Access

https://doi.org/10.3855/jidc.2837

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Abstract

Intrauterine devices (IUD) are frequently used as a family planning procedure in developing countries because they are easy to administer and governmental policies support their use in many countries. It is recommended that IUDs be removed or replaced after 10 years, but longer use is common, especially in developing countries. In some cases, rare infections such as pelvic inflammatory diseases, pelvic tuberculosis, or abdominopelvic actinomycosis related to IUD can develop. Pelvic actinomycosis is a rare disease and is often diagnosed incidentally during surgery. In recent years, there has been an increase in actinomycotic infections mostly due to long-term usage of IUD and forgotten intravaginal pessaries. It usually develops as an ascending infection. It is usually associated with non-specific symptoms such as lower abdominal pain, menstrual disturbances, fever, and vaginal discharge. The disease is sometimes asymptomatic. The rate of accurate preoperative diagnosis for pelvic actinomycosis is less than 10%, and symptoms and imaging studies sometimes mimic pelvic malignancy. This report details a case with abdominopelvic actinomycosis associated with an IUD presenting with highly elevated thromboctye count and small bowel perforation with abscess formation.

Highlights

Actinomycosis is a chronic suppurative and granulomatous infection caused by an anaerobic nonspore forming Gram-positive bacteria of the genus Actinomyces
There are some predisposing factors, such as endoscopy, any upper respiratory or oral cavity operation, immunsupression, and chronic inflammatory disease that may cause this bacteria to pass through mucosal barriers [1]
Abdominopelvic actinomycosis has increased in frequency in recent years and has been associated with bowel perforation, abdominal surgery, and trauma [3]

Summary

Introduction

Case Report A 49-year old woman was referred to the haematology department because of an elevated thrombocyte count She had had dull left lower abdominal quadrant pain for twenty days. On her left lower abdominal quadrant she had a palpable tender and fixed adnexal mass. Laboratory examination revealed mild leucocytosis with a white blood cell count of 17,200/μL, an elevated thrombocyte count of 960000 K/μL, C-reactive peptide was found elevated to 230mg/L, and her Ca125 level was moderately elevated to 58 IU/mL Her cervicovaginal smear result was normal, no organism was isolated, and no malignancy or cervical intraepithelial lesion was seen. At the right side of the uterus, there was an abscess formation containing loops of small intestine, the right fallopian tube and right ovary. The patient was well and she was discharged from hospital on the tenth day, without fever and with normal bowel activity; there were no complications reported in the following six months

Discussion

Findings

19. Moosmayer