D. Antonelli et Jf. Kustrup, Large bowel obstruction due to intrauterine device: Associated pelvic inflammatory disease, AM SURG, 65(12), 1999, pp. 1165-1166
Pelvic actinomycosis associated with the use of intrauterine contraceptive
devices (IUDs) can mimic pelvic malignancy. Recognizing this rare, but not
uncommon complication of IUD use can spare a patient from an extensive surg
ical procedure. If recognized preoperatively, a simple regimen of antibioti
cs can be curative; however, if symptomatic, a limited surgical procedure i
s warranted. We present the case of a 55-year-old woman with a slow, indole
nt course of partial large bowel obstruction and a history of IUD use for o
ver 20 years. A preoperative CT scan revealed a frozen pelvis mimicking a p
elvic malignancy. Exploratory laparotomy revealed a firm, indurated, fibrot
ic reaction in the pelvis involving the uterus, adnexa, and sigmoid colon.
A diverting loop colostomy was performed, and pathology revealed sulfur gra
nules from the extracted IUD that grew Actinomyces. The patient was treated
with the appropriate antibiotics, and during the takedown of the colostomy
6 months later the pelvic inflammation was completely resolved. An extensi
ve review of the literature involving actinomycotic abscesses associated wi
th IUD use reveals a limited number of studies reported in the general surg
ical literature. It behooves the general surgeon to be aware of this unusua
l case so that the appropriate consultation and treatment can be performed
with limited morbidity to the patient.