Exploring the link between long-term intrauterine contraceptive device usage and abdominal actinomycosis in a middle-aged female: A case report

Abstract

Actinomycosis is a rare, chronic, and suppurative disease caused by Actinomyces species, which are filamentous, obligate, Gram-positive bacteria. This report presents a case of anterior abdominal actinomycosis in a 40-year-old female with a history of intrauterine contraceptive device placement. The patient presented with severe abdominal pain, an abdominal mass, low-grade fever, and weight loss. Imaging studies revealed thickening of the left rectus abdominis muscle and pericolic fat stranding. An exploratory laparotomy confirmed dense adhesions from the transverse colon and omentum to the abdominal wall with a purulent discharge. Resection of the affected colon segment and primary anastomosis were performed. Histopathological examination revealed characteristic colonies of Actinomyces within abscesses, confirming the diagnosis of actinomycosis. The patient received appropriate antibiotic therapy and showed improvement. This case highlights the rare occurrence of abdominal wall actinomycosis associated with an intrauterine contraceptive device and emphasizes the importance of considering actinomycosis in the differential diagnosis of abdominal pathologies. Thus, medical history related to intrauterine contraceptive device use should be regarded as in differentials if a patient presents vague abdominal mass and pain, and small details in history should be emphasized and looked upon so that a timely decision can be made for the betterment of the patient.

Keywords: Actinomycosis; abdominal actinomycosis; abdominal mass; abdominal pain; retained IUCD.

Figure 1.

(a) A mass originating from the anterior abdominal wall and (b) an attached mass with omentum after its resection from the anterior abdominal wall.

Figure 2.

(a) Low power view actinomycosis surrounded by dense inflammation on H&E stain (100×) and (b) high power view of actinomycosis surrounded by dense inflammation on H&E stain (400×).