Pelvic actinomycosis presenting as malignant large bowel obstruction: A case report and a review of the literature

Actinomycosis is an infrequent chronic infectious disease. In most cases th e diagnosis is made postoperatively because of its unusual clinical present ation. Moreover, abdominal actinomycosis may mimic cancer, inflammatory bow el disease, or diverticulitis. Delay in diagnosis leading to inadequate man agement and unnecessary procedures has been reported. We report the case of a 49-year-old woman with large bowel obstruction secondary to extensive pe lvic actinomycosis involving the rectosigmoid and cecum. She required emerg ency surgery, which involved both resection and colostomy. A review of the literature on abdominal actinomycosis during the last 50 years is also repo rted. Rarely has emergency surgery been described in this condition. Althou gh the incidence of actinomycosis has decreased, the abdominal-pelvic form has been increasing over the past 10 years secondary to increased prolonged use of the intrauterine device. As the clinical spectrum of actinomycosis has dramatically changed, so have the therapeutic considerations. Aggressiv e surgical management in advanced cases with multiorganic involvement seems to have reemerged in recent years. Consideration of actinomycosis in a wom an with prolonged use of an intrauterine device and symptoms of bowel obstr uction could help to improve the preoperative diagnosis and management of t his rare disease.