LETTERS TO THE EDITOR

 

Colonic obstruction secondary to Actinomyces

Obstrucción colónica secundaria a Actinomyces

 

 

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Key words: Actinomyces. Colonic obstruction. IUD.

Palabras clave: Actinomyces. Obstrucción colon. DIU.

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Dear Editor,

Actinomycosis is an uncommon granulomatous infection by Gram-positive anaerobic bacteria of the genus Actinomyces. A. israelii is a major human pathogen (1).

The most frequent locations for colonization are cervicofacial (50%), abdominal (20%) and thoracic (15-20%). The abdominal actinomycosis predisposing factors include recent surgery, trauma and neoplasias. Certain cases have been associated with the intrauterine contraception device (IUD) (2,3).

 

Case report

A 42-year old woman with an IUD was admitted due to colic pain, diarrhea without pathological products and abdominal distension of two months duration. The physical examination showed a slightly distended and tympanized abdomen. The blood analysis was unremarkable and co-cultures were negative. On colonoscopy, an extrinsic compression at 20 cm from the anal margin prevented progression. Afterwards, the patient presented abdominal pain with peritonism and was diagnosed with a pelvic tumor of 3 x 2.3 cm by computed tomography (CT) scan, suggestive of a teratoma dependent on the left ovary and perforation in the cecum. The patient underwent surgery and a stony tumor mass that infiltrated the retroperitoneum, uterus and both ovaries was resected. Ileocecal resection with ileocolic anastomosis and provisional colostomy was performed as well as removal of the IUD. A pathological anatomy study found Actinomyces on the IUD and in the resected tumor; there was no histological malignancy. After completing antibiotic treatment the patient remains asymptomatic.

 

Discussion

This is a very rare case of colonic subocclusion due to a pelvic mass, secondary to infection by Actinomyces caused by the IUD, with late diastaic perforation of the cecum.

Abdominal infection with Actinomyces is infrequent and has been previously associated with the use of an IUD. These cases may mimic neoplasia (3-5). The diagnosis is anatomopathological. Effective treatment consists of penicillin G 10-20 MU/24h in 4-6 daily doses for 4-6 weeks, followed by oral amoxicillin 2-4 g/24h for 6-12 months (2,5).

 

 

Manuel Alfonso Jiménez-Moreno¹, Isabel Sánchez-Pedrique² and Estíbaliz Obregón-Martínez³
Departments of de ¹Digestive Diseases, ²General Surgery and ³Pathology.
Hospital Universitario de Burgos. Burgos, Spain

 

References

1. Wong VK, Turmezei TD, Weston VC, et al. Actinomycosis BMJ 2011;343. DOI: 10.1136/bmj.d6099.         [ Links ]

2. Cintron JR, Del Pino A, Duarte B, et al. Abdominal actinomycosis. Dis Colon Rectum 1996:39(1):105. DOI: 10.1007/BF02048278.         [ Links ]

3. Yeo Joo Kim, Jina Youm, Jee Hyun Kim, et al. Actinomyces-like organisms in cervical smears: The association with intrauterine device and pelvic inflammatory diseases. Obstet Gynecol Sci 2014:57(5):393-6. DOI: 10.5468/ogs.2014.57.5.393.         [ Links ]

4. Nissi R, Blanco Sequeiros RB, Lappi-Blanco E, et al. Large bowel obstruction in a young woman simulating a malignant neoplasm: A case report of Actinomyces infection. Case Rep Obstet Gynecol 2013;2013:756768. DOI: 10.1155/2013/756768.         [ Links ]

5. Bittencourt JA, Andreis EL, Lima EL, et al. Actinomycosis simulating malignant large bowel obstruction. Braz J Infect Dis 2004;8(2):186-9. DOI: 10.1590/S1413-86702004000200011.         [ Links ]