Abdominal actinomycosis: Complication of endoscopic stenting in chronic pancreatitis?

Pancreatic endotherapy is frequently performed in patients with chronic pan creatitis and stenoses of the main pancreatic duct. In a patient with long- standing chronic pancreatitis and treatment with pancreatic stents, metasta tic pancreatic head carcinoma was suspected because of infiltration of the neighboring organs and hepatic lesions. Ultrasound-guided aspiration of one liver lesion revealed grains typical for actinomycosis. In the light of th is case, an extracted pancreatic stent was microbiologically investigated f or actinomycetes in another patient who had a suspicious lesion of the panc reatic head. Microbiological examination of the extracted pancreatic stent revealed colonization by Actinomyces meyeri, Klebsiella oxytoca, and mixed cultures of anaerobic and saprophytic Gram-positive bacteria. In the follow ing weeks, she developed a septic clinical picture with multiple abscesses of the liver. Actinomyces meyeri, Corynebacterium species; Candida and Ente rococcae were cultivated in the aspirates. It seems possible, that treatmen t with pancreatic stents could have caused invasion of actinomycetes into t he parenchyma of the pancreas, which was already harmed by the chronic infl ammation, followed by the typical infiltrative growth and hematologic or bi liary seeding into the liver.