A Case of Pelvic Actinomycosis Invading the Rectum

Hong, Ki Bong; Choi, Seok Ryeol; Park, Eun Hee; Keum, Dong Joo; Kim, Kwang Jin; Jee, Sam Ryong; Lee, Jong Hoon; Han, Sang Young; Shin, Woo Won

Abstract

Actinomycosis is a rare disease with nonspecific clinical and radiologic findings that are similar to those of other inflammatory and neoplastic conditions. Pelvic actinomycosis has variable clinical manifestations, which makes it difficult to diagnose preoperatively. The diagnosis is often based on histologic demonstration of sulfur granules in discharge from the lesion or surgically resected specimen. Colonization of the lower gastrointestinal tract by Actinomyces occurs most frequently in intrauterine device (IUD) users and increases with the indwelling duration of IUD. It is often treated surgically because pelvic actinomycosis associated with the IUD use resembles pelvic malignancy. However, if the diagnosis of actinomycosis can be obtained preoperatively, the antibiotic treatment may lead to complete resolution. We report a case of pelvic actinomycosis invading the rectum in an IUD user, which was diagnosed by colonoscopic biopsy and Papanicolaou smear before operation. The rectal lesion was improved by the postoperative antibiotic treatment.