Large bowel obstruction due to intrauterine device: Associated pelvic inflammatory disease

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.