Clinical Analysis of Abdominal Actinomycosis: 8 Cases

Yoo, Sang Woo; Park, Sang Woo; Kim, Gun Whan; Son, Chang Mok

Abstract

PURPOSE
Actinomycosis is still a relatively rare infection, characterized by multiple abscesses, draining sinuses and the appearance of sulfur granules, which are valuable in aiding the diagnosing the discharge of involved tissues. In most instances, the onset of an abdominal disease is preceded by inflammatory or a traumatic incident resulting in the perforation of the mucosa of the gastrointestinal tract. Intensive and prolonged antimicrobial therapy, and wide surgical excision of involved tissues are the two general principles of therapy. METHODS: We experienced 8 cases of abdominal actinomycosis after a laparotomy between March 1997 and February 2002. RESULTS: The results were as follows: 1) There was a 1: 1 male to female ratio of abdominal actinomycosis, and a mean age of 47 years. 2) The clinical features were different for each involved organ, -but, most of the clinical symptoms were nonspecific to suspect actinomycosis. 3) The frequently involved organs were mainly located lower abdomen, such as the appendix and cecum, sigmoid colon and small bowel. 4) In 60% of the patients, the predisposing factors were identifiable, these being: a previous abdominal operation, IUD and abdominal injury. 5) The preoperative diagnoses included: acute appendicitis, and periappendiceal and intra-abdominal abscesses. The pre-exploratory diagnoses were made by ultrasound and abdominal CT. 6) Explorations were performed in all patients, depending on their diagnosis, to afford the proper surgical treatment and correct diagnosis. After the operation, all the patients were treated with oral antibiotics for long period. CONCLUSION: The authors conclude that pre-exploratory cytological or culture studies, with careful history taking, for low abdominal tumors or abscesses may increase the rate of correct diagnosis, as could proper explorations.