Korean J Gastroenterol.  2015 Apr;65(4):236-240. 10.4166/kjg.2015.65.4.236.

A Case of Abdominal Wall Actinomycosis

• Kim KH
• Lee J
• Cho HJ
• Choi SB
• Cheung DY
• Kim JI
• Lee IK

• KMID: 2373215
• DOI: http://doi.org/10.4166/kjg.2015.65.4.236

Abstract

Actinomycosis is a chronic suppurative granulomatous infectious disease caused by actinomyces species that is characterized by formation of characteristic clumps called as sulfur granules. Abdominal actinomycosis is a rare disease and is often difficult to diagnose before operation. Abdominal actinomycosis infiltrating into the abdominal wall and adhering to the colon is even rarer. Most abdominal actinomycosis develops after operation, trauma or inflammatory bowel disease, and is also considered as an opportunistic infection in immunocompromised patient with underlying malignancy, diabetes mellitus, human immunodefidiency virus infection, etc. Actinomycosis is diagnosed based on histologic demonstration of sulfur granules in surgically resected specimen or pus, and treatment consists of long-term penicillin based antibiotics therapy with or without surgical resection. Herein, we report an unusual case of abdominal wall actinomycosis which developed in a patient after acupuncture and presented as abdominal wall mass that was first mistaken for abdominal wall invasion of diverticulum perforation.

Keyword

Actinomycosis; Abdominal wall

MeSH Terms

Abdominal Wall/surgery
Actinomycosis/*diagnosis/drug therapy/pathology
Acupuncture
Anti-Bacterial Agents/therapeutic use
Humans
Male
Middle Aged
Tomography, X-Ray Computed
Anti-Bacterial Agents

Figure

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  Fig. 1. CT image shows an ill-defined, heterogeneous enhancing mass at the left upper quadrant of the abdomen that is focally infiltrating into the abdominal wall (arrow) and closely abutting adjacent transverse colon (arrowhead).

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  Fig. 2. Follow-up computed tomography after 4 months shows increased size of enhancing mass with interval progression of infiltration into the abdominal wall and presumably to the transverse colon. Prominent peri-lesional infiltration is also demonstrated.

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  Fig. 3. Abdominal wall actinomycosis conjoined with the transverse colon (10×8 cm).

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  Fig. 4. Gross finding of surgically resected specimen of abdominal wall actinomycosis conjoined with transverse colon which shows central yellowish necrosis.

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  Fig. 5. Surgical repair with Gore-Tex mesh.

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  Fig. 6. Microscopic finding of sulfur granule in the abscess along with surrounding inflammatory cells such as neutrophils and macro-phages (H&E, ×100).

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  Fig. 7. Special stains of sulfur granule (Brown-Bren, ×400; periodic acid-Schiff (PAS), ×400; methenamine silver, ×200; Ziehl-Neelson, ×200).

Reference

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