Abdominopelvic Actinomycosis Associated With an Intrauterine Device and Presenting With a Rectal Mass and Hydronephrosis: A Troublesome Condition for the Clinician

Yilmaz M., Akbulut S., Samdanci E., Yilmaz S.

INTERNATIONAL SURGERY, vol.97, no.3, pp.254-259, 2012 (SCI-Expanded) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 97 Issue: 3
  • Publication Date: 2012
  • Doi Number: 10.9738/cc121.1
  • Journal Name: INTERNATIONAL SURGERY
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus
  • Page Numbers: pp.254-259
  • Keywords: Abdominopelvic actinomycosis, Intrauterine device, Rectum, Tuboovarian structure, Hydronephrosis, OF-THE-LITERATURE, ABDOMINAL ACTINOMYCOSIS, COLON, FEATURES, WALL
  • Inonu University Affiliated: Yes

Abstract

Actinomycosis is an uncommon, chronic, granulomatous disease that can be mistaken for a malignant tumor. Abdominopelvic actinomycosis constitutes about 20% of all actinomycosis cases and may mimic malignancy, tuberculosis, or other abdominopelvic inflammatory diseases. This condition is more prevalent in women who use an intrauterine device. We treated a 44-year-old woman who presented with vaginal discharge, right flank pain, dysuria, and difficulty with defecation. She had anorexia and weight loss (8 kg) during the previous 2 months and had a history of intrauterine device use for 12 years. Clinical, radiologic, and endoscopic examinations revealed a rectal mass and right hydronephrosis. Rectal biopsy showed nonspecific colitis. Laparotomy showed a mass that was invading and obstructing the pelvic orifice. Surgery included total abdominal hysterectomy, bilateral salpingo-oophorectomy, appendectomy, low anterior resection, and Hartmann colostomy. Histopathologic evaluation of surgical specimens showed actinomycosis originating from the tubo-ovarian structures and invading the rectal wall. The patient was placed on penicillin for 6 months, and then had closure of the colostomy with no complication.