Abdominal Actinomycosis Caused by a Fish Bone Penetrating through the Sigmoid Colon which was Successfully Diagnosed Preoperatively

Atsuro Niwa, Takamaori Mitsui, Satoru Moriyama, Masahiko Sugiura, Yoshiaki Ando, Toshinobu Oowa, Kazuo Shibata, Shingi Sasaki, Hidehiko Tsunooka

Department of Surgery, Toyokawa City Hospital

Abdominal actinomycosis is rare, and its diagnosis is difficult to make preoperatively. We report a case of abdominal actinomycosis which was successfully diagnosed preopratively. A 44-year-old man was admitted to our hospital because of an abdominal mass and mild fever. Physical examination revealed a hard, nontender, fixed mass in the left lower abdominal quadrant. Laboratory data showed leucocytosis, thrombocythemia and an elevated CRP level. CT scan demonstrated an infiltrating mass in the anterior left abdomen, extending to the rectal muscle. ⁹⁷Ga scintigraphy showed strong uptake of RI in the mass. Thus it was suspected to be an inflammatory mass, and the patient was treated with antibiotics (SBT/ABPC) intravenously. He improved with this treatment. CT scan on the l5th hospital day revealed a clear straight line with high density in the shrunk mass. Excisional biospy was performed on the 22nd, day, and a diagnosis of abdominal actinomycosis was established by hisotopathtological examination. Resection of the mass carried out on the 35th day. At surgery, the sigmoid colon was adherent to the mass and also a fish bone was found embedded in the mass. We thought that this case was caused by a fish bone penetrating thorough the sigmoid colon. The postoperative course was uneventful, and he discharged on the 14th postoperative day.

Key words
abdominal actinomycosis, fish bone penetaration of the intestine

Reprint requests
Atsuro Niwa Department of Surgery, Toyokawa City Hospital
1-19 Koumei-cho, Toyokawa, 442 JAPAN

Accepted
July 10, 1996

To read the PDF file you will need Abobe Reader installed on your computer.