Wai Clifford Y, Nihira Mikio A, Drewes Peter G, Chang Joe S, Siddiqui Momin T, Hemsell David L
Division of Urogynecology/Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas 75390-9032, USA.
Infect Dis Obstet Gynecol. 2005 Mar;13(1):53-5. doi: 10.1080/10647440400025637.
We report a case of symptomatic actinomycosis associated with vaginal suture erosion and granulation tissue refractory to conservative management, in an outpatient setting.
Three months after total vaginal hysterectomy and uterosacral ligament vaginal vault suspension, a woman complained of painless, intermittent vaginal discharge and spotting. Despite cauterization of granulation tissue, vaginal spotting persisted for another month. On re-examination, braided polyester suture that was found underlying the granulation tissue was removed. Recurrent symptoms, together with a biopsy revealing actinomycetes, prompted a trial of oral penicillin VK. With persistent symptoms and discomfort during attempts in the outpatient clinic, the woman eventually required suture removal in the operating room. Her symptoms subsequently resolved without recurrence, and no further antibiotic treatment was required.
Actinomyces may be associated with persistent granulation tissue and vault suspension suture material. In rare circumstances, when tissue debridement and suture removal in the clinic is unsatisfactory, surgical intervention in the operating room may be necessary. Ten days of antibiotic therapy alone did not eradicate the granulation tissue, and symptoms resolved only after complete removal of the underlying permanent suture.
我们报告一例在门诊环境中出现的有症状放线菌病病例，该病例与阴道缝线侵蚀及保守治疗无效的肉芽组织有关。
在全阴道子宫切除及子宫骶韧带阴道穹隆悬吊术后三个月，一名女性主诉有无痛性、间歇性阴道分泌物及点滴出血。尽管对肉芽组织进行了烧灼，但阴道点滴出血仍持续了一个月。再次检查时，发现肉芽组织下的编织聚酯缝线被移除。反复出现的症状，以及活检发现放线菌，促使尝试口服青霉素V钾。由于在门诊尝试治疗期间症状持续且不适，该女性最终需要在手术室进行缝线拆除。她的症状随后消失且未复发，无需进一步的抗生素治疗。
放线菌可能与持续性肉芽组织及穹隆悬吊缝线材料有关。在罕见情况下，当临床的组织清创和缝线拆除不令人满意时，可能需要在手术室进行手术干预。仅十天的抗生素治疗未能根除肉芽组织，症状仅在完全移除潜在的永久性缝线后才得以缓解。
