Clinical Analysis of Actinomycosis: 66 Cases of Korean Experience

Kim, Man Ki; Sun, Byung Ho

Abstract

Abdominal actinomycosis is a rare entity which presents some difficulty in establishing a correct preoperative diagnosis. The diagnosis is usually based on histologic demonstration of sulfur granules in pus or surgically resected specimen. Treatment has consisted of longterm antibiotic therapy coupled with surgery in complicated cases. The authors analyzed 66 patients of proven abdominal actinomycosis, who consisted of 53 cases previously reported in Korean literatures since 1966 and 13 cases treated at the department of General Surgery, Sae Gang General Hospital since 1990. The results were as follows. 1) Females were more frequently involved. The male to female ratio of abdominal actinomycosis was 1:2.1 and the mean age was 40.3 years-old. 2) Clinical features were different with each involved organ. However, most of the clinical symptoms were nonspecific to suspect actinomycosis. 3) The frequently involved sites were mainly located in the lower abdomen, such as the appendix, omentum, uterus and adnexa, ileocecum, colon, rectum, and small bowel. 4) In 59% of the patients, predisposing factors were identifiable. Identified possible factors were previous appendectomy, IUD, abdominal trauma, abortion, and perforative disorders of the GIT. 5) The preoperative diagnoses were intra-abdominal tumors or abscesses in 67% of the patients. Correct pre-exploratory diagnoses were made in 15% of the patients by using fine needle aspiration cytologic study, culture of drained pus, or direct tissue biopsy. 6) Explorations were performed in 88% of the patients to afford a proper surgical treatment and a correct diagnosis. After operation, almost all patients were treated with oral antibiotics for long periods. The authors conclude that pre-exploratory cytologic or culture study in patients who show uncomplicated low abdominal tumors or abscesses may increase the rate of correct diagnosis and could eliminate unnecessary explorations.