Original Article DOI 10.3349/ymj.2009.50.4.555 pISSN: 0513-5796, eISSN: 1976-2437 Yonsei Med J 50(4): 555-559, 2009 Clinical Features of Abdominopelvic Actinomycosis: Report of Twenty Cases and Literature Review Myung-Min Choi,1 Jeong Heum Beak,1 Jung Nam Lee,1 Sanghui Park,2 and Won-Suk Lee1 Departments of 1 Surgery, 2 Pathology, Gil Medical Center, Gachon University of Medicine and Science, Seoul, Korea. Purpose: Intrabdominal actinomycosis is difficult to diagnose preoperatively. This chronic infection has a propensity to mimic many other diseases and may present with a wide variety of symptoms. The aim of this study was to evaluate the characteristic clinical features with review of the literature. Materials and Methods: We retrospectively analyzed 22 patients with intrabdominal actinomycosis between January 2000 and January 2006. Results: There were two men and 20 women with a mean age of 42.8 years (range, 24 - 69). Twelve patients presented with masses or abdominal pain, whereas 3 patients presented with acute appendicitis. The rate of performing an emergency surgery was 50% due to symptoms of peritonitis. The mean size of tumor was 5.5 cm (range, 2.5 - 11.0). Sixty percent (n = 12) of female patients had intrauterine device (IUD). The average time to definite diagnosis was 10.6 days. Conclusion: Intrabdominal abdominal actinomycosis must first be suspected in any women with a history of current or recent IUD use who presents abdominal pain. If recognized preoperatively, a limited surgical procedure, may spare the patient from an extensive operation. Key Words : Actinomycosis, surgery, intrauterine device Received: September 24, 2008 Revised: November 1, 2008 Accepted: November 10, 2008 Corresponding author: Dr. Won-Suk Lee, Department of Surgery, Gil Medical Center, Gachon University of Medicine and Science, 1198 Guwol-dong, Namdong-gu, Incheon 405-760, Korea. Tel: 82-32-460-1234, Fax: 82-32-460-3009 E-mail: lws@gilhospital.com ∙The authors have no financial conflicts of interest. INTRODUCTION Actinomycosis is a chronic, suppurative, and granulomatous disease caused by an anaerobic Gram-positive bacterium, Actinomyces israelii, manifesting itself as fistula, sinus, inflammatory pseudotumor, or abscess formation.1 Humans are natural reservoirs and there is no documented person-to-person transmission of the disease, and it is commonly cultured from carious teeth, tonsilar crypts.2 It is characterized by a tendency to feign malignancy due to its capacity to invade surrounding tissues and to form masses.3 Therefore, there are multiple clinical presentations, often leading to misdiagnosis. The three main clinical forms of this disease are cervicofacial, thoracic, and abdominopelvic. The cervicofacial region accounts for 50% to 65%, followed by abdomen (20%).4-6 The disease usually shows an indolent course with clinical symtoms and signs that are not specific, resulting in delayed diagnosis. Actinomyces are sensitive to penicillin, but the duration of treatment varies from several weeks to months to achieve permanent recovery.7-10 The aim of this study was to evaluate the charac- teristic clinical features with short literature review on the topic. MATERIALS AND METHODS © Copyright: Yonsei University College of Medicine 2009 Between January 2000 and January 2006, 22 patients with abdominopelvic actinomycosis were identified. Patient’s demographic data and outcome are Yonsei Med J http://www.eymj.org Volume 50 Number 4 August 2009 555