Actinomycosis is a chronic, suppurative, and granulomatous
disease caused by an anaerobic or microaerophilic
gram-positive bacterium, Actinomyces israelii, manifesting
itself as fistula, sinus, inflammatory pseudotumor, or
abscess formation. The cervicofacial region (50 to 65%)
accounts for the majority of the cases followed by abdomen
(20%) (1–5). Abdominal infection mostly involves
the cecal area and can simulate malignant tumor on clinical
and radiological examinations (1, 4, 6, 7). The diagnosis
is almost always ascertained after surgery and histopathological
examination of the specimen.
The purpose of this report is to emphasize the possibility
of encountering an abdominal mass related to actinomycosis
in emergency cases and the benefit of limited surgical
procedure.
A 28-year-old man was admitted to emergency room with
severe right lower abdominal pain, nausea, and vomitting of a
few days’ duration. He had a 4-month history of decrease in
appetite but no weight loss, bloating, and vague lower abdominal
pain. His further medical history revealed hospitalization for
pulmonary tuberculosis 9 years prior. He denied any surgical
procedures.
Physical examination disclosed fever (38◦C) and tachycardia
(110/min). He was noted to have a distended abdomen with
guarding and rebound tenderness, especially in the right upper
and lower quadrants. No abdominal mass was palpated.
Abnormal laboratory values included only a leukocyte count
of 15,800/mm3. Abdominal ultrasound showed pelvic free fluid
and an irregular mass in the right lower quadrant.
The patient underwent an emergency laparotomy with the
presumptive diagnosis of perforated appendicitis and related peManuscript
received March 3, 2004; accepted August 18, 2004.
From the Departments of *General Surgery and †Pathology, Inonu
University School of Medicine, Malatya, Turkey.
Address for reprint requests: Burak I¸sik, MD, Turgut Ozal Tip
Merkezi, Genel Cerrahi AD, Elazig Yolu 15 km, Malatya 44280, Turkey;
bisik@inonu.edu.tr.
riappendicular abscess. Approximately 200 ml of greenish purulant
fluid was aspirated from the pelvis. A large firm tumor
extending from the ascending colon to the hepatic flexure involving
the mesocolon was identified. The second portion of
the duodenum was adherent to the posterior of the mass. The
decision at this juncture was to perform a right hemicolectomy
versus a hemicolectomy with Whipple procedure because of the
duodenal invasion. We preferred to perform a right hemicolectomy
with end-to-end ileocolonic anostomosis, leaving a macroscopically
evident tumor on the duodenal serosa because of not
having a malignancy confirmation of the mass. Further exploration
of the abdominal cavity revealed no other pathological
findings.
