Surgical treatment for abdominal actinomycosis: A report of two cases

Abstract

Since actinomycosis sometimes causes an abdominal tumor which mimics malignancy, treatment strategy varies from case to case. We herein report two cases which were treated with a combination of antibiotics and surgical intervention. Both patients presented with an intra-abdominal tumor lesion mimicking malignant disease after an appendectomy for acute appendicitis. Case 1 received surgical extirpation of the abdominal tumor in the liver and kidney twice since the clinical diagnosis of actinomycosis was not made. In contrast, case 2 was successfully treated by a combination of antibiotics and laparoscopic surgery following the experience of case 1. When a high probability diagnosis can be made, a laparoscopic approach is a useful and effective option to treat this condition.

Keywords: Abdominal actinomycosis; Laparoscopic surgery; Single port surgery; Surgical therapy.

Figure 1

Image findings of case 1. A: Abscess cavity mimicking malignant liver tumor occupied in the posterior segment of the liver; B: Abscess formation found at the right kidney 3 mo after hepatectomy.

Figure 2

Resected liver (A), resected kidney (B) and pathological examination of the resected kidney (C) of case 1. A: The lesion in the resected liver was a macroscopically whitish node with capsule; B: The resected kidney showed the same nature as the liver tumor; C: The pathological examination of the resected kidney revealed a typical abscess due to Actinomyces israelii. Note the abscess contained filamentous bacterial colonies, i.e. sulfur granules.

Figure 3

Preoperative computed tomography image of case 2. Tumor 70 mm × 45 mm in the right flank is observed invading to segment 6 of the liver, showing an irregularly circumferentiated, contrast-enhanced cystic structure with heterogenous content.

Figure 4

Intraoperative images of case 2. A: Liver parenchyma was transected by ultrasonic device. Bleeding was well controlled; B: Intraoperative view of the resected lesion. Operation was completed by single incision laparoscopic surgery without additional port.

Figure 5

Resected specimen (A) and postoperative picture of abdomen (B) of case 2. A: Resected specimen revealed suppurative inflammatory tissue which consisted of abscess, granulomatous- and fibrous tissue in and around the liver; B: Circle indicates surgical wound of single port. Surgical scars of previous appendectomy are seen.