Actinomycosis of the sigmoid colon: A case report

Abstract

Abdominal actinomycosis is a chronic suppurative infection caused by Actinomyces species. The ileo-cecal region is most commonly affected, while the left side of the colon is more rarely involved. The infection has a tendency to infiltrate adjacent tissues and is therefore rarely confined to a single organ. Presentation may vary from non specific symptoms and signs to an acute abdomen. A computed tomography scan is helpful in identifying the inflammatory process and the organs involved. It also allows visual guidance for percutaneous drainage of abscesses, thus aiding diagnosis. Culture is difficult because of the anaerobic character and slow growth of actinomycetes. Colonoscopy is usually normal, but may shows signs of external compression. Preoperative diagnosis is rare and is established only in less than 10% of cases. In uncomplicated disease, high dose antibiotic therapy is the mainstay of treatment. Surgery is often performed because of a difficulty in diagnosis. Surgery and antibiotics are required in the case of complicated disease. Combined medical and surgical treatment achieves a cure in about 90% of cases. The authors report a case of sigmoid actinomycosis where diagnosis was made from the histology, and a review of the literature is presented.

Keywords: Abdominal pain; Actinomycosis; Gram-positive bacteria; Sigmoid colon; Sulfur.

Figure 1

Surgical specimen: Sigmoid colon mass (80 mm × 30 mm) with abscess formation.

Figure 2

Histology: A colony of Actinomyces is seen within the pericolonic inflammatory tissue.

Figure 3

Gram-positive staining of an Actinomyces colony.