González BOM, Motta RGA, Uscanga CMC, Aguilar HR

Language: Spanish
References: 18
Page: 179-188
PDF size: 629.07 Kb.

ABSTRACT

Introduction: The actinomicosis is a chronic infection, produced mainly by Actinomyces israelii, anaerobial bacteria that usually inhabit the oropharynx, the gastrointestinal tract and the vaginal channel. The pathogenesis of the actinomycotic abdominopelvic affection is secondary to the disruption of the mucous barriers, for inflammatory processes, trauma, intestinal surgery and strange bodies, such as the intra-uterine (DIU) device or intra-vaginal device. The invasive abdominopelvic actinomycosis is characterized by the identification of pelvic complex mass and affection to adjacent tissues due to adjacent dissemination whose characteristics through imaging are undefined and frequently confused with a pelvic new tissue growth.
Objective: To document the more frequent tomography findings found in abdominopelvic actinomycosis.
Materials and method: Six patients were retrospectively studied with histopathological diagnostic of abdominopelvic actinomycosis to characterize the tomography findings.
Results: For the six female patients, abdominal or pelvic complex mass was demonstrated, with relevant later reinforcement to the contrast IV of the solid portion and/or the wall thereof. In the 100% of the patients, affection was observed in other organs: ureter (four cases), rectosigmoids (three cases), bladder (two cases), small intestine (one case) and abdominal wall (one case). There was association with DIU in four patients (66%).
Conclusions: Although the findings for computerized tomography (CT) are unspecified, before a patient that shows up with a pelvic complex mass, affection to other organs and DIU in situ, the possibility of abdominopelvic actinomycosis shall be included in the differential diagnosis, since the diagnostic suspicion by means of biopsy of the lesion is proven, the patient will be benefit by antibiotic therapy (betalactamic agents), avoiding an unnecessary surgery.

REFERENCES

1. Hawnaur JM, Reynolds K, McGettigan C. Magnetic resonance imaging of actinomycosis presenting as pelvic malignancy. BJR 1999; 72: 1006-11.

2. Ho S, Hyup S, Mo D, Kim KA. Unusual causes of tubo-ovarian abscess: CT and MR imaging findings. Radiographics 2004; 24: 1575-89.

3. Lely RJ, Es HW. Case 85: Pelvic actinomycosis in association with an intrauterine device. Radiology 2005; 236: 492-4.

4. O’Connor KF, Bagg MN, Croley MR, Schabel SI. Pelvic actinomycosis associated with intrauterine devices. Radiology 1989; 170: 559-60.

5. Maloney JJ, Cho SR. Pelvic actinomycosis. Radiology 1983; 148: 388.

6. Sánchez JA, Mercado NA, Chilaca F, Rivera JA. Uso del DIU asociado a la infección secundaria por actinomyces en tracto genital femenino. Rev Esp Patol 2004; 37: 383-90.

7. Owen K, Flannery MT, Elaini AB, Rivera J. Actinomycotic tumor of the abdominal wall. Southern Medical Journal 2004; 97: 175-7.

8. Arend SM, Oosterhof H, Van Dissel JT. Actinomyces and the intrauterine device. Archives of Internal Medicine 1998; 158: 1270-1.

9. Lee IJ, Kwon H, Min Ch, et al. Abdominopelvic actinomycosis involving the gastrointestinal tract: CT features. Radiology 2001; 220: 76-80.

10. Dahnert W. Radiology Review Manual. 5th Ed. Philadelphia: Lippincot Williams and Wilkins; 2003.

11. Hochsztein JG, Koenigsberg M, Green DA. US Case of the day. RadioGraphics 1996; 16: 713-6.

12. Saad M, Moorman J. Actinomyces hepatic abscess with cutaneous fistula. NEJM 2005; 353: 18-20.

13. Arifuddin R, Baichi M, Ullah A, Maliakkal B. Actinomycotic splenic abscess after colonoscopy and colon polypectomy. J Clin Gastroenterol 2006; 8: 764-5.

14. Powell JL, Cunill ES, Kotwall CA, Turner JF, McKinney CD. Advanced pelvic actinomycosis infection mimicking malignancy. J Pelvic Med Surg 2005; 11: 269-73.

15. Peipert JF. Actinomyces: normal flora or pathogen? Obstet Gynecol 2004; 104: 1132-3.

16. Lippes J. Pelvic actinomycosis: a review and preliminary look at prevalence. Am J Obstet Gynecol 1999; 180: 265-9.

17. Horrow MM. Ultrasound of pelvic inflammatory disease. Ultrasound Quarterly 2004; 20: 171-9.

18. Fiorino AS. Intrauterine contraceptive device-associated actinomycotic abscess and actinomyces detection on cervical smear. Obstet Gynecol 1996; 87: 142-9.