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[Pelvic actinomycosis: just think of it].
Gynecol Obstet Fertil. 2010 May; 38(5):307-12.GO

Abstract

OBJECTIVES

Pelvic actinomycosis is a rare disease that can be diagnosed before, during or after surgical treatment of a suspected ovarian tumor, a suspected bowel obstruction, or acute peritonitis. The possibility of early detection of pelvic or abdominal abscess related to was evaluated through a personal series and literature review.

PATIENTS AND METHODS

Our series of 11 cases of severe abdominal or pelvic actinomycosis is related and compared to 58 cases reported in the literature.

RESULTS

Seven patients in this series were diagnosed with pelvic inflammatory disease and acute peritonitis with or without bowel obstruction, and four women were diagnosed after surgical treatment for suspected ovarian cancer. Fifty-two of the 58 cases of reproductive tract actinomycosis reported in the literature review and all our cases were associated with prolonged use of an intrauterine contraceptive device with a mean of eight years. The contribution of pelvic ultrasound and angioscanner in evaluating these patients should not be underestimated and MRI may be useful in some cases as well. Early diagnosis based on Actinomyces-positive cervical smears or abscess aspiration was accomplished only once in our series and was rare in literature. A histopathologic diagnosis during laparoscopy or laparotomy could avoid more difficult and extensive surgery. In our series of 11 patients, five women required abdominal surgery, five required salpingo-oophorectomy and three required hysterectomy. All women required surgical intervention. Effective treatment combined long antibiotic therapy with surgery. Correct preoperative diagnosis is rare but if achieved, long-term treatment with penicillin for at least two months and sometimes up to a year may completely eradicate the infection. Surgery may still be necessary to improve medical treatment or to resolve pelvic abscesses.

DISCUSSION AND CONCLUSION

Any pelvic abscess occurring in a woman with a history of long-term use of an intrauterine device should be considered as possible pelvic actinomycosis. If there is no fever in association with an atypical adnexal tumor, frozen section should be obtained during surgery to rule out the diagnosis of actinomycosis.

Authors+Show Affiliations

Pôle de gynécologie, obstétrique, médecine foetale, reproduction humaine et génétique, hôpital Bretonneau, 2, boulevard Tonnellé, 37044 Tours cedex 1, France. marret@med.univ-tours.frNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

English Abstract
Journal Article
Review

Language

fre

PubMed ID

20430667

Citation

Marret, H, et al. "[Pelvic Actinomycosis: Just Think of It]." Gynecologie, Obstetrique & Fertilite, vol. 38, no. 5, 2010, pp. 307-12.
Marret H, Wagner N, Ouldamer L, et al. [Pelvic actinomycosis: just think of it]. Gynecol Obstet Fertil. 2010;38(5):307-12.
Marret, H., Wagner, N., Ouldamer, L., Jacquet, A., & Body, G. (2010). [Pelvic actinomycosis: just think of it]. Gynecologie, Obstetrique & Fertilite, 38(5), 307-12. https://doi.org/10.1016/j.gyobfe.2010.03.006
Marret H, et al. [Pelvic Actinomycosis: Just Think of It]. Gynecol Obstet Fertil. 2010;38(5):307-12. PubMed PMID: 20430667.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Pelvic actinomycosis: just think of it]. AU - Marret,H, AU - Wagner,N, AU - Ouldamer,L, AU - Jacquet,A, AU - Body,G, Y1 - 2010/04/28/ PY - 2010/01/08/received PY - 2010/03/06/accepted PY - 2010/5/1/entrez PY - 2010/5/1/pubmed PY - 2010/8/13/medline SP - 307 EP - 12 JF - Gynecologie, obstetrique & fertilite JO - Gynecol Obstet Fertil VL - 38 IS - 5 N2 - OBJECTIVES: Pelvic actinomycosis is a rare disease that can be diagnosed before, during or after surgical treatment of a suspected ovarian tumor, a suspected bowel obstruction, or acute peritonitis. The possibility of early detection of pelvic or abdominal abscess related to was evaluated through a personal series and literature review. PATIENTS AND METHODS: Our series of 11 cases of severe abdominal or pelvic actinomycosis is related and compared to 58 cases reported in the literature. RESULTS: Seven patients in this series were diagnosed with pelvic inflammatory disease and acute peritonitis with or without bowel obstruction, and four women were diagnosed after surgical treatment for suspected ovarian cancer. Fifty-two of the 58 cases of reproductive tract actinomycosis reported in the literature review and all our cases were associated with prolonged use of an intrauterine contraceptive device with a mean of eight years. The contribution of pelvic ultrasound and angioscanner in evaluating these patients should not be underestimated and MRI may be useful in some cases as well. Early diagnosis based on Actinomyces-positive cervical smears or abscess aspiration was accomplished only once in our series and was rare in literature. A histopathologic diagnosis during laparoscopy or laparotomy could avoid more difficult and extensive surgery. In our series of 11 patients, five women required abdominal surgery, five required salpingo-oophorectomy and three required hysterectomy. All women required surgical intervention. Effective treatment combined long antibiotic therapy with surgery. Correct preoperative diagnosis is rare but if achieved, long-term treatment with penicillin for at least two months and sometimes up to a year may completely eradicate the infection. Surgery may still be necessary to improve medical treatment or to resolve pelvic abscesses. DISCUSSION AND CONCLUSION: Any pelvic abscess occurring in a woman with a history of long-term use of an intrauterine device should be considered as possible pelvic actinomycosis. If there is no fever in association with an atypical adnexal tumor, frozen section should be obtained during surgery to rule out the diagnosis of actinomycosis. SN - 1769-6682 UR - https://www.unboundmedicine.com/medline/citation/20430667/[Pelvic_actinomycosis:_just_think_of_it]_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1297-9589(10)00085-8 DB - PRIME DP - Unbound Medicine ER -