Abdominal Pain Research Articles

New Insights into Ruling Out Internal Herniations After Laparoscopic Gastric Bypass on the Abdominal CT Scan: The OPERATE study

Abstract Background Internal herniation (IH) is a potentially life-threatening complication after gastric bypass. Accurate diagnosis of IH remains challenging. This study aims to validate the Eindhoven2020 (EHV20) scoring system for ruling out IH and seeks to improve its diagnostic accuracy through additional radiologic parameters. Methods Patients participating in a prospective study on abdominal pain after gastric bypass surgery were selected if a CT scan was performed. CT scans were scored following the EHV20 scoring system containing ten signs of IH to confirm the individual and collective accuracy of these signs. Also, we evaluated the diagnostic value of additional radiologic parameters: delayed passage of contrast, dilated intestinal loops, and free fluid. Results A total of 375 patients with abdominal pain were included. IH was confirmed during laparoscopy in 27 patients. On CT, the highest sensitivity was achieved by the swirl sign (66.7%) and the highest specificity by a small bowel behind the superior mesenteric artery (99.7%). The area under the receiver operating characteristic curve (AUC) based on the EHV20 scoring system for ruling out IH was 0.845 (95% CI 0.730–0.959). The AUC could be improved to 0.905 (95% CI 0.825–0.985) (p = 0.088) through the incorporation of several additional signs. Overall, this new scoring system included swirl sign, small bowel obstruction, enlarged nodes, venous congestion, mesenteric edema, dilated alimentary or biliary loop, free fluid, and backward flow in the biliary loop with possible backflow in the residual stomach. Conclusions Incorporation of additional CT signs into an existing scoring system can help clinicians to safely rule out IH in patients with abdominal pain after bariatric surgery.

Case report: Successful laparoscopic management of early abdominal pregnancy

BackgroundAbdominal pregnancy is characterized by the implantation of the gestational sac within the peritoneal cavity, specifically outside the fallopian tubes, ovaries, and cervix. This exceedingly rare form of ectopic pregnancy accounts for about 1% of all ectopic pregnancies. When rupture occurs, it can result in a life-threatening situation for the patient, necessitating immediate medical intervention.Case informationIn this study, we report a 33-year-old female patient who presented with abdominal pain and was subsequently diagnosed with an early abdominal pregnancy. Laparoscopic intervention revealed gestational tissue and a rupture site located in the pouch of Douglas. The gestational tissue was successfully excised via laparoscopy, and the rupture site was sutured to achieve hemostasis. Postoperative histopathological analysis confirmed the presence of chorionic villi and trophoblast cells.ConclusionThis case highlights the critical importance of precise diagnosis and laparoscopic intervention in the management of abdominal pregnancy. It is imperative for clinicians to exercise a prudent approach in the diagnosis and treatment of abdominal pregnancy, utilizing a comprehensive assessment that integrates medical history, clinical manifestations, and auxiliary diagnostic tests to enhance the detection and comprehension of this condition.

Development of a Pediatric Age-Based and Weight-Adjusted Nomogram for Bladder Volumes Associated With Successful Completion of Transabdominal Pelvic Ultrasound (TPU).

To develop a nomogram for pediatric bladder volumes associated with the successful completion of transabdominal pelvic ultrasound (TPU) in female pediatric patients presenting with lower abdominal and/or pelvic pain in the emergency department. This study hypothesizes that the target bladder volumes for successful TPU vary by age and weight. We retrospectively calculated bladder volumes on all successful transabdominal pelvic ultrasound studies during a 2-year period for patients 8 to 18 years old by ellipsoid bladder volume formula using the largest cross-sectional areas captured on transverse and longitudinal cine clips. Measurements were collected by 2 study personnel with initial measurements validated by a pediatric radiologist. Bladder volume by age and weight percentile groups were descriptively analyzed, and a quantile regression model was used to regress bladder volume on age adjusting for patient weight. We analyzed bladder volumes from 1030 successful transabdominal pelvic ultrasound studies. The greatest drop in median volume was seen amongst non-overweight children in younger age groups. Nomogram bladder volumes for transabdominal pelvic ultrasound increase consistently with age and weight until approximately 13 years old and 60kg, respectively, with minimal change thereafter in patients 13 to 18 years old. We provide a pediatric age-based and weight-adjusted nomogram for bladder volumes associated with successful transabdominal pelvic ultrasound imaging. Further evaluation of its use is warranted to decrease inefficiency in bladder filling prior to TPU completion and improve timeliness in diagnosing pelvic emergencies.

Pneumatosis intestinalis in systemic sclerosis: navigating diagnostic and therapeutic challenges.

Pneumatosis intestinalis, characterised by the presence of intramural bowel gas, is a radiological finding with varied clinical implications, ranging from incidental detection to severe underlying pathology, including bowel ischaemia or perforation. Its association with systemic sclerosis, a connective tissue disorder, remains rare and poorly understood, presenting unique diagnostic and therapeutic challenges. A comprehensive literature review was conducted, analysing 34 documented cases of pneumatosis intestinalis associated with systemic sclerosis, examining demographic profiles, clinical features, diagnostic findings, and outcomes of various management strategies. Pneumatosis intestinalis in systemic sclerosis predominantly occurs in older female patients and is associated with gastrointestinal dysmotility and microvascular damage. Symptoms range from asymptomatic presentations to severe abdominal pain with obstructive symptoms, with the latter increasing the likelihood of surgical intervention. Non-operative management, encompassing antibiotic therapy, oxygen supplementation, and dietary modifications, was associated with favourable outcomes and the lowest mortality. In contrast, surgical intervention, often necessitated by suspected ischemia or perforation, was associated with significantly higher morbidity and mortality. Pneumatosis intestinalis in systemic sclerosis is a complex clinical entity demanding a nuanced, multi-disciplinary approach to management. Non-operative management should remain the cornerstone of treatment for clinically stable presentations, with surgery reserved for those with clear indications. The absence of standardised guidelines underscores the need for further research to refine diagnostic criteria and therapeutic protocols, ultimately improving long-term outcomes in this complex intersection of gastrointestinal and systemic disease.

Stones Unearthed: A Journey to Wellness with Ayurvedic Urolithiasis (Mutraashmasri) Management

Urolithiasis is a prevalent clinical condition impacting over 10% of the population in industrialized nations, causing symptoms like intense renal pain, lower abdominal discomfort, painful urination, and cloudy or foul-smelling urine. Despite various medical treatments, managing renal calculi proves financially burdensome, with recurrent stone formation posing a persistent challenge. Ayurvedic diagnostics, including assessing individual constitution (Prakriti), urine (Mutra), and pulse (Nadi), lay the foundation for understanding Mutraashmari causes. Renal calculi are closely linked to Agni (digestive fire) imbalances and the accumulation of Ama (toxins). Ayurvedic interventions aim to enhance Agni, eliminate Ama, and restore Doshic equilibrium, encompassing dietary changes, lifestyle adjustments, and herbal formulations. This case report presents a 45-year-old male with renal calculi (7.7mm at ureteropelvic junction and 7.4mm at ureter-bladder junction) experiencing severe pain, backache, hematuria, and recurrent urinary tract infections. After ineffective allopathic treatment, the patient sought Ayurvedic care, achieving complete urolithiasis dissolution within one month.

POCUS the Pelvis: A Case Series of Timely Diagnoses in Pediatric Patients With Abdominal Pain.

Abdominal pain is a frequent presenting complaint in the pediatric emergency department (PED). Point-of-care ultrasound (POCUS) can expedite the diagnosis and management of patients in the PED with abdominal pain. We present a series of 6 patient cases in which a "POCUS the pelvis" approach expedited diagnosis of undifferentiated abdominal pain in the PED, and thus facilitated definitive management.

Complications of Percutaneous Irreversible Electroporation for Pancreatic Cancer: A Systematic Review

Abstract Objective The aim of the study was to systematically review the percutaneous irreversible electroporation (IRE) complications for pancreatic ductal adenocarcinoma (PDAC). Methods This systematic review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Two independent reviewers conducted a detailed search in PubMed and EMBASE databases from inception till May 2024. The studies reporting the complications of percutaneous IRE in PDAC using standard scales were included. The primary outcome of interest was the complication rate (including total number of complications and major and minor complications) associated with the percutaneous IRE. IRE-related mortality was also recorded. Results Of the 2,324 studies, 14 (9 prospective and 3 retrospective) met the inclusion criteria. Of the 748 complications, 114 were major complications (15.2%) and 634 were minor complications (84.7%). The most common complications were abdominal pain (n = 137), diarrhea (n = 57), and nausea and/or vomiting (n = 45). Pancreatitis (n = 57), vascular thrombosis (n = 21), bleeding (n = 21), and biliary complications (n = 26), including bile leaks, cholangitis, and strictures, were other common complications. The overall IRE mortality was 4/584 (0.68%). IRE-related fatal complications included duodenal perforation (n = 2), hepatic artery and superior mesenteric artery thrombosis (n = 1), and purulent peritonitis (n = 1). Conclusion Although complications are common after IRE for PDAC, most are minor complications. Major complications include bleeding and pancreaticobiliary complications.

Acute abdomen in the era of immune checkpoints inhibitors – what the surgeon needs to know: A narrative review

Immune checkpoint inhibitors (ICI) have been approved for the treatment of a variety of malignancies. Immune-related adverse events are rare and might affect a lot of different organs including the intestines. Enterocolitis is a common complication characterised by symptoms such as diarrhoea, abdominal pain, and vomiting. In rare circumstances, bowel perforation, obstruction, or even toxic megacolon might appear. The proper therapeutic management of these conditions is based on case reports or case series. Conservative management is the standard of care in the case of ileus, however, the safety of performing a bowel anastomosis has not been answered yet. This study aims to raise awareness among the medical community, and specifically surgeons, regarding the intestinal complications of ICI, as the uprising administration of these targeted therapies makes this knowledge necessary.

Abdominal Pain and Dysuria Secondary to Chronic Recreational Ketamine Use: A Case Report on K-cramps

Abdominal Pain and Dysuria Secondary to Chronic Recreational Ketamine Use: A Case Report on K-cramps

A challenging case of recurrent cholangitis caused by isolated bile duct metastasis of colorectal adenocarcinoma – rescue therapy through EUS-guided hepaticoesophagostomy.

A 64-year-old male was admitted with fever, abdominal pain and jaundice. Medical history was relevant for colorectal adenocarcinoma eleven years before and right hepatectomy due to liver metastasis. MRCP revealed left hepatic duct stenosis without liver nodules. ERCP was performed for biliary drainage with plastic stents. After inconclusive brush cytology, cholangioscopy (Spyglass™DS2) was performed showing villous mucosa surrounded by irregular vessels suggestive of tumor neovascularization. Spybite™ biopsies confirmed biliary metastasis of colorectal origin. The patient started palliative chemotherapy being readmitted six months later with acute cholangitis. Diffuse infiltrating intrabiliary lesion with 120mm was detected in control MRCP. Given its intraductal extension and gastric compression by the hypertrophied liver leading to duodenoscope mispositioning, transpapilar stents could not be deployed. Multiorgan dysfunction developed despite broad-spectrum antibiotics and EUS-guided biliary drainage was proposed. Although EUS access was limited by gastric bulging, puncture of a dilated intrahepatic duct was accomplished with a 19G needle. PCSEMS (GIOBOR™8x100mm) placement was only possible above the gastroesophageal junction with the proximal flare being incidentally deployed in a 3cm intraparietal esophageal tract. The misplaced stent was immediately recanalized and a stent-in-stent FCSEMS (Wallflex™80x10mm) allowed the hepaticoesophagostomy creation. Since the stent opening was orally oriented in esophageal lumen, parenteral nutrition was started to avoid contamination. Sepsis recovering and liver tests normalization were observed. Before hospital discharge stent reposition was planned to resume oral feeding. After placement of a third stent-in-stent NCSEMS (Wallflex™120x10mm) in the hepaticoesophagostomy to prevent migration, the proximal flare was oriented to the stomach gently pushing with the endoscope aiding by an inflated biliary balloon. The patient resumed chemotherapy but died 8 months after due to disease progression. Isolated bile duct metastasis is an uncommon complication of colorectal cancer. EUS-guided hepaticoesophagostomy is feasible when puncture through the esophagus was inevitable, especially in patients with liver hypertrophy.

The Effect of Natural Mineral Water on Regulators of Gastroduodenal Motility in Young Adults: a Comparative Controlled Study

INTRODUCTION. Drinking balneotherapy has long been successfully used for pathologies of the digestive system. However, the sanogenetic mechanisms of normalization of gastrointestinal motility when using drinking mineral waters have not been sufficiently studied. AIM. To assess the dynamics of the level of hormones that regulate gastric motility with a single dose of moderately mineralized sulfate-sodium-calcium mineral water in a young adults to reveal their sanogenetic role in functional dyspepsia. MATERIALS AND METHODS. 3 groups were formed: the first — 57 people with postprandial distress syndrome (PDS), the second — 57 with epigastric pain syndrome (EPS), the third — 56 healthy people. All subjects were assessed for gastroenterological symptoms using a specific validated Gastrointestinal Symptom Rating Scale (GSRS) questionnaire, and the levels of motilin and cholecystokinin in the blood were determined before and after taking 200 ml of mineral water. RESULTS. The level of motilinemia in patients with PDS initially (9811.67 ± 48.34 pg/ml) did not have significant differences from the level of healthy people (9665.64 ± 106.94 pg/ml) (p = 0.379), with EPS it was lower (8780.67 ± 102.94 pg/ml) (p = 0.000). In healthy people, the concentration of motilin in the blood after taking mineral water did not undergo statistically significant changes (p = 0.59), in patients with PDS it led to a decrease in its level by 13.8 % (p = 0.000), in patients with EPS it increased by 9.3 % (p = 0.000). The value of cholecystokininemia in EPS (180.6 ± 5.83 pg/ml) turned out to be statistically significantly higher (p = 0.008), and in PDS (116.67 ± 3.32 pg/ml) lower (p = 0.000) than in healthy group (146.64 ± 6.24 pg/ml). After drinking mineral water, healthy people experienced an increase in cholecystokininemia by 21.5 % (p = 0.003), in the group of patients with PDS — by 43.6 % (p = 0.000), with EPS — without significant dynamics (p = 0.491). CONCLUSION. Features of the dynamics of the level of motilin and cholecystokinin in the blood of healthy people and with functional dyspepsia in response to a single dose of mineral water were revealed, which play an important role in the sanogenetic effect of drinking balneotherapy for gastric motility disorders.

Gastric cancer metastasizing to the male reproductive system.

A 71-year-old male patient underwent a radical gastrectomy for gastric cancer two years prior and subsequently received regular postoperative chemotherapy with capecitabine and oxaliplatin. Six months before admission, he experienced the onset of swelling in the right inguinal region, accompanied by pain in the right lower abdomen during ambulation. He was admitted to the hospital due to the progressive enlargement of the swelling and the onset of severe abdominal pain. Physical examination revealed a protruding mass in the right groin, which was apparent upon standing and did not recede upon compression of the internal ring orifice. During the unilateral inguinal hernia repair procedure, multiple nodular masses were identified at the internal ring's opening, with the largest measuring approximately 2 cm in diameter and exhibiting a hard texture. Subsequent tissue excision for pathological analysis revealed heterogeneous cellular structures and swelling that extended along the spermatic cord, reaching the vas deferens and spermatic vessels, and invading the peritoneum. The hernial sac was smooth and devoid of hernial contents, leading to the resection of the affected peritoneum. During the surgical procedure, the spermatic cord was transected and ligated proximal to the testis, followed by its removal. Subsequently, the posterior wall of the inguinal canal was reinforced with sutures, the surgical field was irrigated with no evidence of active bleeding, and the incision was closed. Histopathological analysis revealed metastatic involvement of the spermatic cord and testis by gastric cancer, thereby confirming ectopic metastasis of the malignancy.

Duodenal obstruction after non-endoscopic intragastric balloon placement: a rare but severe complication.

We report the case of a mid-30s woman with no prior medical history who presented to the emergency department with intense upper abdominal pain lasting 12 hours. She had undergone the placement of a non-endoscopic, swallowed intragastric balloon the day before. Physical examination revealed significant tenderness in the upper abdomen without signs of peritoneal irritation. Abdominal computed tomography showed a 12-cm balloon lodged in the duodenum with peritoneal effusion but no evidence of free perforation.

Drugs for Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is a common disorder characterized by recurrent abdominal pain and altered bowel habits, often accompanied by bloating.1-4 IBS is classified by its predominant bowel symptom: constipation (IBS-C), diarrhea (IBS-D), mixed type (IBS-M), or unclassified (IBS-U).1 Since the exact cause of IBS is unknown, the goal of treatment is symptom control.

Comparison Chart: Some Drugs for Abdominal Pain in Irritable Bowel Syndrome (IBS)

Comparison Chart: Some Drugs for Abdominal Pain in Irritable Bowel Syndrome (IBS)

Escherichia coli in medicolegal autopsy causing symmetrical peripheral gangrene and psoas abscess

Postmortem microbiology (PMM) plays a crucial role in identifying infectious causes of death, which have significant legal and clinical implications. Not only determining the cause of death, PMM is vital in identifying infectious pathogens providing valuable medical insights. This case series presents two medicolegal autopsy cases where Escherichia coli infections led to rare and severe complications: Symmetrical peripheral gangrene (SPG) and psoas abscess. The first case involves a 28-year-old female hospitalized for 35 days after allegedly consuming sedatives. Postmortem findings included gangrene in her hands and feet and extensive lung consolidation with pus nodules. Blood cultures identified E. coli, while lung swabs revealed Klebsiella pneumoniae and Candida spp. The second case involves a 32-year-old female experiencing abdominal pain and breathing difficulties who died en route to the hospital. The autopsy revealed congested lungs and a psoas abscess, with blood cultures confirming E. coli infection. E. coli, typically associated with urinary tract infections, can cause severe complications such as SPG and psoas abscess. SPG involves ischemic damage to extremities without central vessel occlusion, often linked to septicemia and disseminated intravascular coagulation. Psoas abscesses result from hematogenous spread or direct extension from adjacent structures. These cases highlight the need to consider atypical pathogen presentations in critically ill patients. Recognizing E. coli’s potential for rare, fatal complications emphasizes the importance of thorough microbiological analysis during autopsies to improve diagnostic accuracy, guide clinical management, and inform public health strategies. Integrating PMM into routine autopsy protocol is essential for advancing medical and forensic knowledge.

The Impact of Ramadan Fasting on Dyspeptic Complaints.

Dyspepsia, a common gastrointestinal issue characterized by upper abdominal discomfort, can be influenced by diet, medication, and lifestyle changes. Ramadan fasting involves refraining from food and drink from dawn to sunset, affecting various physiological processes, including digestion. The fasting period can range from 12 to 18 hours depending on the year, potentially impacting the prevalence of dyspeptic symptoms. This study aimed to assess the effect of fasting on dyspeptic symptoms, taking into account demographic and clinical factors. A cohort study examined 1258 clinic patients, with 150 meeting specific inclusion criteria. Dyspepsia was diagnosed using Rome IV criteria, with fasting hours taken into consideration. The relationship between dyspepsia, fasting, Non-Steroidal Anti-Inflammatory Drug use, and demographics was analyzed. Dyspepsia was more prevalent in females (32%) compared with males (23%), with a higher proportion of non-fasting women among dyspeptic patients. Older patients (>65y) had a higher prevalence of dyspepsia (P = 0.026). Fasting individuals had a 2.1 times greater likelihood of experiencing dyspeptic symptoms. Although Non-Steroidal Anti-Inflammatory Drug use was lower in fasting patients, no significant association with dyspepsia was observed (P = 0.139). Ramadan fasting increases the risk of dyspeptic symptoms, particularly in women and older adults. Factors such as medication timing and dietary changes during fasting may contribute to this risk. Highlighting the importance of the pre-dawn meal (Suhoor) in managing dyspeptic symptoms is essential. Tailored guidance should be provided to individuals at higher risk during Ramadan.

Review Article: Surrogate Endpoints to Assess Treatment Efficacy in Disorders of Gut-Brain Interaction of Lower Gastrointestinal Tract.

Surrogate endpoints such as laboratory parameters that are not direct measurements of, but predict, clinical benefit are approved by regulatory agencies for initial proof of efficacy. No surrogate endpoints are approved for disorders of gut-brain interaction. To assess the correlation of scintigraphic colonic transit (CT) with response rates according to patient-reported symptom-based endpoints (composite/global symptoms, abdominal pain or stool frequency/consistency) in irritable bowel syndrome (IBS) or chronic idiopathic constipation (CIC). We reviewed available data from, randomised controlled trials (RCTs) reporting effects on CT at 24 h and 48 h with drug versus placebo and extracted the difference in the proportions responding to drug or placebo, using rates from individual RCTs or from meta-analyses when more than one RCT existed for a drug. We analysed associations between differences (drug vs. placebo) in CT and in response rates using Spearman correlation. Additional analyses of CT at 24 h with composite/global symptom or pain endpoints were performed with exclusion of alosetron (the only drug slowing CT). CT at 24 h correlated significantly with composite/global symptom endpoints (Rs = -0.755, p = 0.021). CT correlated with stool frequency or consistency (at 24 h, Rs = 0.506, p = 0.074; at 48 h, Rs = 0.631, p = 0.026). CT at 24 h did not correlate with abdominal pain (Rs = -0.054, p = 0.843). With the exclusion of alosetron data, CT at 24 h was non-significantly correlated with the composite/global symptom endpoint (Rs = -0.667, p = 0.073), but not with abdominal pain (Rs = 0.377, p = 0.419). Scintigraphic CT measurement fulfils the expectation of a surrogate endpoint for symptom-based outcomes, particularly in IBS-D or IBS-C and CIC.

Complications of Menstrual Regulation in a Tertiary Care Hospital in Dhaka city of Bangladesh: A Cross Sectional Study

Background: Menstrual regulation is an alternate important way of reproductive life of females. Objective: The purpose of this present study was to find out the outcomes of complications of menstrual regulation. Methodology: This observational cross-sectional study was conducted on 384 unsafe MR cases were included in this study in the Department of Obstetrics and Gynecology, Shaheed Suhrawardy Medical College Hospital, Dhaka, Bangladesh, over the period of 12 (twelve) months, dated from January 2011 to December 2011.A data collection sheet was formed which included all the parameters and variables of interests. After selection, eligible women were informed about the study and a written consent was taken. In this observational study all women were to be interviewed, their detail history, findings of physical examination and investigation reports were checked and the information’s were recorded in the data collection form. Results: The age of the patients ranged from 16 to 40 years and most of the patients belonged to ’26 to 30 years’ age group is 31.8%. The mean duration of stay was 7.32 days and the total duration ranged from 1 to 28 days. In spite of the large range of stay, more than half 53.3% of the respondents were released from the hospital within 3 days. In this study shows that the respondents were having various difficulties following abortion induction; most of them were suffering from abdominal pain was the most prevailing condition [358 (93.2%)] followed by per vaginal bleeding 90.1%. The complications of the patients developed following unsafe abortion. The most complications found Four-fifth of the cases 80.2% were found with retained product of conception. More than one-fifth were in shock 21.6%and another one-fifth were suffering from per vaginal bleeding 20.0%. Conclusion: Menstrual Regulation happens mostly in unsafe abortion leading to comorbidity of life even death. Journal of National Institute of Neurosciences Bangladesh, January 2024;10(1):64-69

Actinomycosis: Mimicking Malignancies in Multiple Anatomical Sites—A Three-Patient Case Series

Background and Objectives: Actinomycosis is a rare chronic contagion caused by Actinomyces spp. known for its ability to mimic malignant processes across various anatomical locations. Its clinical presentation can often resemble malignancies, Mycobacterium tuberculosis infections, nocardiosis, fungal infections, or other granulomatous diseases. This case series presents three patients diagnosed with Actinomyces spp., highlighting the diagnostic challenges and diverse clinical manifestations of the disease. Materials and Methods: We reviewed the clinical course, diagnostic procedures, and treatment outcomes of three patients with confirmed Actinomyces spp. The first case involved a 51-year-old male with a history of rhabdomyosarcoma in remission who presented with dysphagia. Magnetic resonance imaging identified an irregularly enhancing mass in the tonsil, and subsequent tonsillectomy confirmed Actinomyces spp. The second patient, an 80-year-old female, presented with dysphagia and a sublingual mass initially suspected to be diffuse large B-cell non-Hodgkin lymphoma; however, a histopathological analysis confirmed Actinomyces spp. The third case involved a 72-year-old male with abdominal pain and an ulcerated gastric lesion, where subtotal gastrectomy and histopathological examination confirmed the diagnosis of Actinomyces spp. Results: These three cases highlight the ability of Actinomyces spp. to closely mimic malignant lesions, which significantly complicates the diagnostic process. Although personalized interventions were required for each patient, diagnoses were ultimately confirmed through histopathology. Despite these challenges, timely recognition and appropriate treatment were achieved, underscoring the need to consider Actinomyces spp. in the differential diagnosis of similar presentations. Conclusions:Actinomyces spp. remains a diagnostic challenge due to its ability to mimic a variety of malignant and contagion conditions. This case series emphasizes the need for a thorough histopathological examination and a high index of suspicion when encountering lesions with atypical presentations. Given the potential for misdiagnosis, awareness and consideration of Actinomyces spp. are crucial in the differential diagnosis of chronic contagion and mass lesions. Further studies are warranted to refine diagnostic and therapeutic approaches.