Department of Surgical Oncology, Regional Hospital of Jendouba, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.
Department of Surgical Oncology, Salah Azaiez Institute, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.
Womens Health (Lond). 2023 Jan-Dec;19:17455057231181009. doi: 10.1177/17455057231181009.
Pelvic actinomycosis with an intrauterine device accounts for approximately 3% of all actinomycoses. It is a chronic infectious disease characterized by infiltrative, suppurative, or granulomatous inflammation, sinus fistula formation, and extensive fibrosis, and caused by filamentous, gram-positive, anaerobic bacteria called . The slow and silent progression favors pseudo tumor pelvic extension and exposes the patient to acute life-threatening complications, namely colonic occlusion with hydronephrosis. Preoperative diagnosis is often difficult due to the absence of specific symptomatology and pathognomonic radiological signs simulating pelvic cancer. We discuss the case of a 67-year-old woman who complained of pelvic pain, constipation, and weight loss for 4 months, and who presented to the emergency department with a picture of colonic obstruction and a biological inflammatory syndrome. The computed tomography scan revealed a suspicious heterogeneous pelvic mass infiltrating the uterus with an intrauterine device, the sigmoid with extensive upstream colonic distension, and right hydronephrosis. The patient underwent emergency surgery with segmental colonic resection and temporary colostomy, followed by antibiotic therapy. The favorable clinical and radiological evolution under prolonged antibiotic therapy with the almost total disappearance of the pelvic pseudo tumor infiltration confirms the diagnosis of pelvic actinomycosis and thus makes it possible to avoid an extensive and mutilating surgery with important morbidity.
带宫内节育器的盆腔放线菌病约占所有放线菌病的 3%。它是一种慢性传染病，其特征为浸润性、化脓性或肉芽肿性炎症、窦道形成和广泛纤维化，由丝状、革兰阳性、厌氧细菌引起，称为 。缓慢而无声的进展有利于假性肿瘤盆腔延伸，并使患者面临急性危及生命的并发症，即伴有肾积水的结肠阻塞。由于缺乏特异性症状和模拟骨盆癌的特征性放射学征象，术前诊断往往较为困难。我们讨论了一位 67 岁女性的病例，她因盆腔疼痛、便秘和体重减轻 4 个月而就诊，并因结肠阻塞和生物炎症综合征就诊于急诊科。计算机断层扫描显示可疑的异质性盆腔肿块浸润子宫，宫内节育器，乙状结肠伴有广泛上游结肠扩张和右侧肾积水。患者接受了紧急手术，行结肠节段切除术和临时结肠造口术，随后进行抗生素治疗。在延长抗生素治疗下，临床和放射学均得到良好的改善，盆腔假性肿瘤浸润几乎完全消失，从而明确了盆腔放线菌病的诊断，避免了广泛和致残性的手术，减少了重要的发病率。
