Ayoub Firas, Asour Amani, Miah Anur
General and Colorectal Surgery, Medway Maritime Hospital, Gillingham, GBR.
General and Colorectal Surgery, Dartford and Gravesham NHS Trust, Kent, GBR.
Cureus. 2024 Sep 19;16(9):e69763. doi: 10.7759/cureus.69763. eCollection 2024 Sep.
Abdominal actinomycosis is a rare disease caused by the bacteria. We report a case series of two similar cases with a mismatch between the initial differential diagnosis, the radiological findings, the surgical findings, and the actual histological result. The first case is a 25-year-old woman with a month's history of right-sided abdominal pain. The diagnostic workup including computed tomography (CT) showed possible acute appendicitis, in addition to ascending colon looking abnormal with inflammatory changes and adjacent peritoneal nodules. A diagnostic laparoscopy revealed a normal-looking appendix and a hard mass involving the ascending colon potentially of inflammatory or malignant origin. A laparoscopic right hemicolectomy was performed. Surprisingly, the histology concluded actinomycosis. The second case is a 38-year-old woman with a six-week history of lower abdominal pain and right iliac fossa (RIF) swelling. The diagnostic workup including a CT scan showed a complex mass suggesting complicated appendicitis, pelvic inflammatory disease, or neoplastic process. Furthermore, magnetic resonance imaging (MRI) of the pelvis showed complex bilateral cystic lesions in both iliac fossas with an abscess formation within the subcutaneous fat overlying the lower pelvis. The patient underwent an ultrasound (US)-guided drainage of the subcutaneous pelvic collection and a diagnostic laparoscopy that showed an inflamed mass with dense adhesions to the anterior abdominal wall. Intraoperative biopsies were taken to confirm the diagnosis, which ultimately confirmed severe pelvic actinomycosis. Both patients were discharged home and received extended antibiotic treatment according to microbiology guidelines with good outcomes. Both cases are interesting because there was a mismatch between the initial differential diagnosis, the radiological findings, the intraoperative findings, and the final histology. Reported cases in the literature highlight the diagnostic challenges of abdominal actinomycosis, as it often presents with atypical symptoms and imaging findings sometimes mimic malignancy leading to surgical intervention.
腹部放线菌病是一种由细菌引起的罕见疾病。我们报告了一个包含两例相似病例的系列病例，这些病例在初始鉴别诊断、影像学检查结果、手术发现以及实际组织学结果之间存在不匹配。第一例是一名25岁女性，有一个月的右侧腹痛病史。包括计算机断层扫描（CT）在内的诊断检查显示可能为急性阑尾炎，此外升结肠外观异常，有炎症改变以及相邻的腹膜结节。诊断性腹腔镜检查显示阑尾外观正常，升结肠有一个硬块，可能为炎症性或恶性起源。进行了腹腔镜右半结肠切除术。令人惊讶的是，组织学检查结果为放线菌病。第二例是一名38岁女性，有六周的下腹痛和右髂窝（RIF）肿胀病史。包括CT扫描在内的诊断检查显示一个复杂肿块，提示为复杂性阑尾炎、盆腔炎性疾病或肿瘤性病变。此外，骨盆的磁共振成像（MRI）显示双侧髂窝有复杂的囊性病变，在下骨盆上方的皮下脂肪内形成脓肿。患者接受了超声（US）引导下的盆腔皮下积液引流以及诊断性腹腔镜检查，检查显示一个发炎的肿块与前腹壁紧密粘连。术中进行活检以确诊，最终确诊为严重的盆腔放线菌病。两名患者均出院回家，并根据微生物学指南接受了延长疗程的抗生素治疗，效果良好。这两个病例都很有意思，因为在初始鉴别诊断、影像学检查结果、术中发现以及最终组织学检查之间存在不匹配。文献报道的病例突出了腹部放线菌病的诊断挑战，因为它常常表现为非典型症状，影像学表现有时类似恶性肿瘤，从而导致手术干预。
