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Ureteral and sigmoid obstruction caused by pelvic actinomycosis in an intrauterine contraceptive device user.
Gynecol Obstet Invest 2002; 54(4):228-31GO

Abstract

We report herein a rare case of ureteral and sigmoid obstruction caused by pelvic actinomycosis in a patient fitted with an intrauterine contraceptive device (IUCD). A 63-year-old Japanese woman was admitted complaining of lower abdominal pain and slight fever continuing for a month. She had a history of IUCD insertion 30 years previously and had been menopausal for the past 10 years. Ultrasonography and CT scan revealed a solid pelvic mass involving the uterus, sigmoid colon, urinary bladder, and right ureter. The IUCD was detected in the uterine cavity. Right hydronephrosis and hydroureter due to an obstruction of the distal ureter and the extensive stenosis of the sigmoid colon were also observed. Blood analysis showed leukocytosis, thrombocytosis, and elevated C-reactive protein levels. Although pathological and microbiological analysis of the removed IUCD showed negative results for Actinomyces infection, these findings suggested a pelvic abscess caused by actinomycosis. Benzyl penicillin administration was started immediately. Total hysterectomy, bilateral salpingo-oophorectomy, and lysis of adhesion around the ureter were performed. Actinomycosis was diagnosed based on histologic examination. The patient's postoperative course was uneventful except for persistent mild hydroureter and hydronephrosis. The patient is now healthy without evidence of recurrent Actinomyces infection 1 year after treatment. As shown in the present case, pelvic actinomycosis should be considered as a cause of pelvic inflammatory disease in IUCD users, even though Actinomyces was not detected on the IUCD.

Authors+Show Affiliations

Department of Obstetrics and Gynecology, Oita Medical University, Oita, Japan. nasu@oita-med.ac.jpNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

12592067

Citation

Nasu, Kaei, et al. "Ureteral and Sigmoid Obstruction Caused By Pelvic Actinomycosis in an Intrauterine Contraceptive Device User." Gynecologic and Obstetric Investigation, vol. 54, no. 4, 2002, pp. 228-31.
Nasu K, Matsumoto H, Yoshimatsu J, et al. Ureteral and sigmoid obstruction caused by pelvic actinomycosis in an intrauterine contraceptive device user. Gynecol Obstet Invest. 2002;54(4):228-31.
Nasu, K., Matsumoto, H., Yoshimatsu, J., & Miyakawa, I. (2002). Ureteral and sigmoid obstruction caused by pelvic actinomycosis in an intrauterine contraceptive device user. Gynecologic and Obstetric Investigation, 54(4), pp. 228-31.
Nasu K, et al. Ureteral and Sigmoid Obstruction Caused By Pelvic Actinomycosis in an Intrauterine Contraceptive Device User. Gynecol Obstet Invest. 2002;54(4):228-31. PubMed PMID: 12592067.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Ureteral and sigmoid obstruction caused by pelvic actinomycosis in an intrauterine contraceptive device user. AU - Nasu,Kaei, AU - Matsumoto,Harunobu, AU - Yoshimatsu,Jun, AU - Miyakawa,Isao, PY - 2002/02/25/received PY - 2003/2/20/pubmed PY - 2003/8/9/medline PY - 2003/2/20/entrez SP - 228 EP - 31 JF - Gynecologic and obstetric investigation JO - Gynecol. Obstet. Invest. VL - 54 IS - 4 N2 - We report herein a rare case of ureteral and sigmoid obstruction caused by pelvic actinomycosis in a patient fitted with an intrauterine contraceptive device (IUCD). A 63-year-old Japanese woman was admitted complaining of lower abdominal pain and slight fever continuing for a month. She had a history of IUCD insertion 30 years previously and had been menopausal for the past 10 years. Ultrasonography and CT scan revealed a solid pelvic mass involving the uterus, sigmoid colon, urinary bladder, and right ureter. The IUCD was detected in the uterine cavity. Right hydronephrosis and hydroureter due to an obstruction of the distal ureter and the extensive stenosis of the sigmoid colon were also observed. Blood analysis showed leukocytosis, thrombocytosis, and elevated C-reactive protein levels. Although pathological and microbiological analysis of the removed IUCD showed negative results for Actinomyces infection, these findings suggested a pelvic abscess caused by actinomycosis. Benzyl penicillin administration was started immediately. Total hysterectomy, bilateral salpingo-oophorectomy, and lysis of adhesion around the ureter were performed. Actinomycosis was diagnosed based on histologic examination. The patient's postoperative course was uneventful except for persistent mild hydroureter and hydronephrosis. The patient is now healthy without evidence of recurrent Actinomyces infection 1 year after treatment. As shown in the present case, pelvic actinomycosis should be considered as a cause of pelvic inflammatory disease in IUCD users, even though Actinomyces was not detected on the IUCD. SN - 0378-7346 UR - https://www.unboundmedicine.com/medline/citation/12592067/Ureteral_and_sigmoid_obstruction_caused_by_pelvic_actinomycosis_in_an_intrauterine_contraceptive_device_user_ L2 - https://www.karger.com?DOI=10.1159/000068379 DB - PRIME DP - Unbound Medicine ER -