外科ジャーナル

Great Omentum Actinomycosis. Is it Feasible Laparoscopic Approach?

Abstract

Eugen Târcoveanu, Alin Vasilescu, Dan Andronic, Cristian Lupașcu, Delia Ciobanu and Costel Bradea

Introduction: Abdominal Actinomycosis is a rare granulomatous inflammatory disease caused by a Gram-positive anaerobic bacterium Actinomyces israeli, manifesting as a pseudoinflamatory tumor, or abscess formation. Evolution is slow and steady in inflammatory contiguous extension without a limit organ that lends itself to confusion with abdominal malignancies.
Methods: We performed a retrospective study between 1980 to 2018, by analyzing all medical records on 13 patients with abdominal actinomycosis operated in First Surgical Clinic, "St. Spiridon" Emergency University Hospital Iasi.
Results: There were 4 men and 9 women with a mean age of 44.07 years who were hospitalized with abdominal tumors (7 cases) in men and pelvic inflammatory disease in women (6 cases). We identified as predisposing factors: IUD maintained over 10 years (6 cases), 2 foreign bodies (a toothpick probably perforated colon, gallstones lost in peritoneum), and diabetes (3 cases). As a location, most were abdomino-pelvic mass (7 cases) which have evolved as an adnexal tumor or pelvic inflammatory disease and abdominal tumors in the ileo-cecal region (3 cases) or in the proximity of the transverse colon (3 cases). Was rarely suspected preoperatively the diagnosis by imaging (CT is the gold standard). The diagnostic was specified by histopathology exam. All cases were operated by laparotomy (9 cases) or laparoscopic approach (4 cases). We performed the drainage of an abdominal abscess (3 cases), adnexectomy and peritoneal drainage (4 cases), colon resection (3 cases) and omentum tumor resection (2 cases). Also the IUD it was extracted. All patients were treated with penicillin for 15-42 days. We recorded three relapses requiring further surgery to have made the short-term treatment with penicillin. The authors report two cases of great omentum actinomycosis approached laparoscopically who underwent resection of tumour followed by specific treatment with penicillin, with a good postoperative course.
Conclusion: Laparoscopic approach in abdominal actinomycosis is feasible. Tumor or abscess of actinomycosis benefit from surgical treatment without major organ sacrifice, completed by antibiotic therapy (penicillin) for at least 6 weeks. Follow up is required, relapses are possible.