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Case Reports
. 2010 Jun;3(3):134-138.
doi: 10.4021/gr2010.05.207w. Epub 2010 May 20.

Actinomycosis of the Pancreas: A Case Report and Review

Amalanshu Jha  1 , Anusak Yiengpruksawan  2 , Arthur A Christiano  3 , Neeti Jha  4 , Prajna Latika  5
Affiliations
Case Reports

Actinomycosis of the Pancreas: A Case Report and Review

Amalanshu Jha et al. Gastroenterology Res. 2010 Jun.

Abstract

Actinomyces is a normal commensal of the upper aerodigestive tract, colon and female reproductive tract. It can give rise to invasive disease in case of any breach in mucosal integrity, as well as, in patients with immunosuppression. Rarely, actinomycosis can involve the pancreas especially after episodes of pancreatitis or in post operative patients. We observed a case of actinomycosis affecting recurrent intraductal papillary mucinous neoplasm (IPMN) of pancreatic remnant, 5 years after a Whipple's procedure. Our patient, a 66 years old male with a history of Whipple's procedure for IPMN of pancreatic uncinate process, presented with repeated episodes of acute pancreatitis. Repeated radiological investigations (CT, MRI and EUS) revealed resolving pancreatitis with recurrent IPMN of the pancreatic tail. The patient underwent laparobotic assisted resection of the remnant pancreas and spleen 3 months later. Intraoperatively, in addition to the recurrent IPMN of pancreatic tail, we found a dense peripancreatic desmoplastic reaction with areas of thick yellow pus pockets in the remnant pancreatic body. Bacteriology and histopathology revealed it as a recurrent IPMN associated with actinomycosis of pancreas with chronic xanthogranulomatous changes. We conclude that actinomycosis of the pancreas is a rare entity with only 5 cases reported in English literature to the best of our knowledge. If diagnosed preoperatively, early institution of antibiotics can improve the surgical outcome. Fortunately, after diagnosis, we were able to start antibiotics in early postoperative period with successful outcome.

Keywords: Actinomycosis; Intraductal papillary mucinous tumor (IPMN); Pancreas.

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Figures

Figure 1
Figure 1
Acute pancreatitis with fluid collection.
Figure 2
Figure 2
Recurrent IPMN cyst of pancreatic tail.
Figure 3
Figure 3
Pancreatic duct stenosis with distal dilatation.
Figure 4
Figure 4
Gross specimen of resected remnant pancreas with spleen.
Figure 5
Figure 5
Branching bacterial filaments at the edge of sulfur granule. Note surrounding inflammation.
See this image and copyright information in PMC

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