Cintron J R, Del Pino A, Duarte B, Wood D
Department of Surgery, The West Side Veterans Administration Hospital and Medical Center, Chicago, Illinois 60612, USA.
Dis Colon Rectum. 1996 Jan;39(1):105-8. doi: 10.1007/BF02048278.
Actinomyces israelii are normal inhabitants in the oral cavity and upper intestinal tract of humans. They rarely cause disease and are seldom reported as pathogens. As a pathogen it causes fistulas, sinuses, and may appear as an abdominal mass and/or abscess. The abdominal mass can masquerade as a malignant process that is very difficult to differentiate, often requiring surgical intervention with resection. Because of difficulty in making a preoperative diagnosis, we undertook this review to determine if all patients require surgical intervention and whether other adjunctive modalities may improve preoperative diagnosis.
We report two patients with abdominal actinomycosis, one affecting the sigmoid colon and the other the retroperitoneum, iliac crest region. Both simulated a malignant process and required operations for diagnosis and treatment.
As reported, actinomycotic abdominal masses and strictures can be treated by penicillin alone. Long-term medical treatment seems to be very successful and avoids surgical resection. The difficulty is obtaining a definitive diagnosis.
The computed tomographic scan is the most helpful diagnostic modality. Appearance of abdominal actinomycosis is usually a contrast enhancing multicystic lesion as was found in these two patients. Needle aspiration cytology can be fairly accurate in obtaining the diagnosis and is recommended for suspicious lesions.
以色列放线菌是人类口腔和上消化道的正常寄居菌。它们很少引起疾病，很少被报道为病原体。作为病原体，它可导致瘘管、窦道，并可能表现为腹部肿块和/或脓肿。腹部肿块可能伪装成难以鉴别的恶性病变，常常需要手术切除干预。由于术前诊断困难，我们进行了这项综述，以确定是否所有患者都需要手术干预，以及其他辅助手段是否可以改善术前诊断。
我们报告了两名腹部放线菌病患者，一名累及乙状结肠，另一名累及腹膜后、髂嵴区域。两者均伪装成恶性病变，需要手术进行诊断和治疗。
如前所述，放线菌性腹部肿块和狭窄单用青霉素即可治疗。长期药物治疗似乎非常成功，可避免手术切除。困难在于获得明确诊断。
计算机断层扫描是最有用的诊断方法。腹部放线菌病的表现通常是增强扫描的多囊性病变，这在这两名患者中均有发现。针吸细胞学检查在获得诊断方面可以相当准确，对于可疑病变建议采用。
