Actinomycosis is a rare, chronic, suppurative, and granulomatous bacterial disease. The Actinomyces species exist as normal flora in the oropharynx, gastrointestinal tract, and the female genital tract. They are incapable of penetrating the normal mucous membranes and become pathogenic only when this barrier has been destroyed by trauma, surgery, immunosuppression, or after viscus perforation. We report the first case of an actinomycotic abscess after laparoscopic sleeve gastrectomy. A 29-year-old man underwent a laparoscopic sleeve gastrectomy with no intra-operative complications. On postoperative day 3, the patient had a fever with elevated inflammatory markers. Abdominal computerized tomography (CT) with oral water-soluble contrast media showed no extra-luminal leakage and no fluid collection adjacent to the resected stomach, other than the fluid collection in the right subhepatic space. Percutaneous drainage was attempted, but the procedure failed due to the patient's thick abdominal wall. After two weeks of weight loss of about 12 kg, percutaneous drainage was successfully performed, and A. odontolyticus was identified through pus culture. After effective abscess drainage and high-dose antibiotics, the patient's symptoms improved and the abscess pocket disappeared. We reported Actinomyces infection after gastric sleeve surgery. In the case of abscess formation after gastric sleeve surgery caused by actinomycete infection, antibiotic treatment and percutaneous drainage are effective together.

Actinomycosis is a granulomatous disease caused by filamentous, gram-positive, anaerobic bacteria. Actinomycetes are commensal inhabitants of the oral cavity and intestinal tract but acquire pathogenicity through invasion of breached or necrotic tissue.1397645907In abdominal actinomycosis (AA), the appendix and ileocecal region are usually involved. The aim of this study was to characterize patients diagnosed with AA and to establish the risk factors for appendiceal actinomycosis, including a short review of the literature.

We conducted a prospective cohort study of all patients diagnosed with AA in the University Hospital Marques de Valdecilla (Santander-Cantabria) from January 2003 to October 2013. We also conducted a short review of the literature.

We characterized the epidemiological features of patients diagnosed with AA and risk factors for the involvement of the appendix, as most of the cases were misdiagnosed as appendicitis. Risk factors for appendiceal actinomycosis are no antecedents of carcinoma (P = 0.034) and previous incorrect diagnosis (P = 0.006).

AA is a rare and chronic infection. It is only reported in case reports in the literature. We present the largest series of patients diagnosed with AA. Half of the patients had morbidities, mostly carcinoma, and penicillin was the preferred treatment. More studies are needed to characterize patients affected with AA and to establish the correct treatment.

This is a case of a 75-year-old man being admitted to the on-call surgical department with acute abdominal pain. On arrival he was clinically dehydrated and shocked with localised pain over McBurney's point and examination findings were suggestive of appendiceal or other colonic pathology. Full blood testing revealed a white cell count of 38×10(9)/L and a C reactive protein (CRP) of 278 mg/L. A CT scan revealed a gallbladder empyema that extended into the right iliac fossa. This case highlights the potential for a hyperdistended gallbladder empyema to present as acute right iliac fossa pain with blood tests suggestive of complicated disease. Further analysis confirmed Actinomyces infection as the underlying aetiology prior to a laparoscopic subtotal cholecystectomy. This case serves to remind clinicians of this as a rare potential cause of atypical gallbladder pathology.

Omental actinomycosis without any predisposing factors is rare, and there are few reports on it invading the contiguous bowels to form fistulae. We describe the case of a 55-year-old male patient with omental actinomycosis that presented as an inflammatory tumor that formed fistulae with the transverse colon and upper jejunum. On admission, he had complaints of a palpable, tender mass on the left mid-abdomen without gastrointestinal symptoms. After 7 days of conservative treatments (NPO and intravenous antibiotics), the size of the mass was decreased and tenderness was more improved. Laparoscopic resected omental mass revealed fistulae to the colon and jejunum. There was no evidence of Crohn disease. After 1-week use of antibiotics owing to the concern about actinomycosis, the mass was decreased and it was more amenable to dissect laparoscopically.

This study was designed to evaluate the clinical features of abdominal actinomycosis and to assess its therapeutic outcome. We reviewed patients with abdominal actinomycosis in Seoul St. Mary hospital, between January 1994 and January 2010. Twenty-three patients (5 male and 18 female, mean age, 47.8 yr; range, 6-75 yr), with abdominal actinomycosis were included. Emergency surgery was performed in 50% due to symptoms of peritonitis. The common presentation on preoperative computerized tomography was a mass with abscess, mimicking malignancy. The mean tumor size was 7.0 cm (range, 2.5-10.5). In all patients, actinomycotic masses were surgically removed. Mean duration of hospital stay was 17.8 days (range, 5-49). Long term oral antibiotic treatment (mean 4.2 months; range, 0.5-7.0 months) were administered to all patients. All patients were free of recurrence after a median follow up of 30.0 months (mean 35.5 ± 14.8 months, range, 10.0-70.0 months); recurrence was not seen in any patient. In conclusion, abdominal actinomycosis should be included as a differential diagnosis when an unusual abdominal mass or abscess presents on abdominal CT. Assertive removal of necrotic tissue with surgical drainage and long term antibiotic treatment provide a good prognosis in patients with actinomycosis.

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.

We retrospectively analyzed 22 patients with intrabdominal actinomycosis between January 2000 and January 2006.

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.

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.

Actinomycosis of the gallbladder is very rare. Herein, we report the case of a 50-year-old man who presented with acute right hypochondrial pain, fever and rigors associated with positive Murphy's sign. Ultrasound showed that the gallbladder had multiple stones and an oedematous thick wall. The preoperative diagnosis was acute cholecystitis. The patient responded to conservative treatment with antibiotics. Laparoscopic cholecystectomy was performed 6 weeks later but was converted to open surgery because of dense adhesions to the duodenum and sealed duodenal perforation. Microscopic examination of the gallbladder showed moderate to severe inflammation with formation of microabscesses and numerous colonies of actinomycetes. We also review the literature on this rare disease. Although surgery is essential, prolonged postoperative antibiotic is required.

Actinomycosis is a rare, chronic, spreading, suppurative, granulomatous and fibrosing infection. Actinomyces are normal inhabitants of the oral cavity and gastrointestinal tract. They rarely cause disease and are seldom reported as pathogens. Herein, we reported on a 69-year-old male patient who had undergone Whipple's operation due to ampulla Vater carcinoma, and became infected with actinomycosis at the pancreaticojejunostomy, which mimicked a recurrent malignancy. He was treated with radical resection of the mass at the pancreaticojejunostomy and had an uneventful postoperative course.

A case of a periappendiceal actinomycosis, seen in an 83-year-old woman, clinically mimicking a right ovarian neoplasm penetrating the right colon, is presented. The patient's complaints led to the discovery of a right abdominal mass. Explorative laparotomy and right hemicolectomy were done. Histological examination revealed periappendiceal actinomycotic abscesses. We discuss a possible pathogenesis and the therapeutic modalities.

Fistulas are abnormal communications between two epithelial-lined surfaces. Gastrointestinal fistulas encompass all such connections that involve the alimentary tract, and they can be congenital or acquired in nature. This review focuses on acquired gastrointestinal fistulas. Development of an acquired gastrointestinal fistula can greatly affect patient outcome, yet the clinical manifestations are often protean in nature and the etiology, elusive. Imaging plays an important role in the detection and management of acquired gastrointestinal fistulas. The more routine use of cross-sectional imaging (especially computed tomography and magnetic resonance imaging) has altered the standard sequence of radiologic evaluation for possible fistulas, but fluoroscopic studies remain a valuable complement, especially for confirming and defining the anomalous communications. In this review, a classification scheme for gastrointestinal fistulas is provided, major causes are discussed, and individual fistula types are elaborated with an emphasis on contemporary imaging approaches.

A 55-year-old female patient is described who had recurrent retroperitoneal infections without an apparent focus. After a protracted period of illness the infection proved to be caused by actinomycosis. An unusual feature of the inflammatory process consisted of obstruction of the ureters, ultimately resulting in destruction of the left kidney. Hydronephrosis resulting from inflammatory fibrosis has not been reported in the literature before.

Actinomyces israelii are normal inhabitants in the oral cavity and upper intestinal tract of humans. They rarely cause disease and are seldom reported as pathogens. As a pathogen it causes fistulas, sinuses, and may appear as an abdominal mass and/or abscess. The abdominal mass can masquerade as a malignant process that is very difficult to differentiate, often requiring surgical intervention with resection. Because of difficulty in making a preoperative diagnosis, we undertook this review to determine if all patients require surgical intervention and whether other adjunctive modalities may improve preoperative diagnosis.

We report two patients with abdominal actinomycosis, one affecting the sigmoid colon and the other the retroperitoneum, iliac crest region. Both simulated a malignant process and required operations for diagnosis and treatment.

As reported, actinomycotic abdominal masses and strictures can be treated by penicillin alone. Long-term medical treatment seems to be very successful and avoids surgical resection. The difficulty is obtaining a definitive diagnosis.

The computed tomographic scan is the most helpful diagnostic modality. Appearance of abdominal actinomycosis is usually a contrast enhancing multicystic lesion as was found in these two patients. Needle aspiration cytology can be fairly accurate in obtaining the diagnosis and is recommended for suspicious lesions.

Actinomycosis is an unusual intra-abdominal infection, often mistaken for other conditions. We report a case associated with bilateral ureteric obstruction in which a recto-sigmoid stricture developed in previously normal bowel, followed by its complete resolution after treatment with antibiotics, as demonstrated by serial barium enema examinations.

A case of histologically proven actinomycosis of the greater omentum is reported. Computed tomography (CT) showed a mass at the greater omentum near the left flank area; it was hypervascular on angiograms and was supplied by the omental artery originating from the splenic artery. Sonography showed that the echogenecity of the lesion was complex. Actinomycosis of the greater omentum, although rare, should be included in the differential diagnosis of omental mass.