A Case of Abdominal Actinomycosis with Resection of Multiple Organs

Hiroyuki Kawamura, Makoto Kataoka, Yoshiyuki Kuwabara, Yasuyuki Kureyama, Hiroshi Iwata, Noriyuki Shinoda, Taketoshi Kashima, Atsushi Satou, Kouji Hattori, Kouichirou Nakano, Akira Masaoka

Second Department of Surgery, Nagoya City University Medical School

A 53-year-old woman was admitted because of a mass in the right lower abdomen with tenderness. Laparotomy revealed a mass in the ileocecal region, and a diagnosis of a malignant neoplasm involving the ileum, sigmoid colon, and the right ovarium was made. The tumor was removed with multiple organ resection, but a diagnosis of abdominal actinomycosis was established postoperatively by histopathological examination. A clinical problem with this disease is the difficulty in preoperative differentiation from malignant tumors. We reviewed the records of 121 patients (59 males and 55 females with a mean age of 48 years) who were operated on for abdominal actinomycosis between 1957 and 1991, and examined the clinical findings and image findings that may be useful for preoperative diagnosis of this disease. The tumor occurs commonly in the ileocecal region and the transeverse colon, and abdominal pain and an abdominal mass were common clinical complaints. Characteristic features of the tumor were hardness, tenderness, and poorly movablility. The white blood cell count was normal in about half the patients. Ultrasonography and computed tomography visualized the lesions as pooly defined and nonhomogeneous masses. Radiological findings of the absess cavity in the tumor, thickening of the intestinal wall around the mass, and an increase in the computed tomography value in the adipose tissue are considered to be useful for diagnosis. Balium enema findings varied from displacement to circumferential constriction of the intestinal wall, but relative intactness of the mucosa was a common feature.

Key words
abdominal actinomycosis

Reprint requests
Hiroyuki Kawamura Second Department of Surgery, Nagoya City University Medical School
1 Kawasumi, Nizuho-cho, Mizuho-ku, Nagoya, 467 JAPAN

Accepted
November 11, 1992

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