Large bowel obstruction in a young woman simulating a malignant neoplasm: a case report of actinomyces infection

Abstract

Pelvic and intra-abdominal Actinomycosis can be difficult to diagnose preoperatively and it may also mimic many other diseases, including malignancies. We present a patient with pelvic Actinomycosis probably caused by a long-standing intrauterine device (IUD). We emphasize the challenges in diagnostic process and stress that though a rare disease, intra-abdominal Actinomycosis should be suspected in cases with intra-abdominal mass of uncertain etiology. The early recognition may spare the patient from extensive surgical operation.

Figure 1

(a) An abdominal radiograph reveals multiple fluid levels and a dilated bowel segment (arrow heads), (b) a CT scan from upper abdomen exhibits dilated colon structure (black arrowheads), narrowed colonic segment (white arrowhead), and extraluminal infiltration (arrow), and (c) A CT scan from lower abdomen exhibits cystic involvement in right ovary (arrowheads) as well as enlarged colon (asterisk).

Figure 2

Cotton ball-like bacterial aggregates consistent with Actinomyces species infection in an HE-stained section of an ovarian abscess (a) and a Papanicolaou-stained cervical smear (b). Bar = 0.1 mm.