Pelvic actinomycosis: beware the intrauterine contraceptive device

Publisher Website
Google Scholar
Abstract
Actinomycosis of the abdomen and pelvis is known as “the great imitator” because of its varied clinical presentations. This, together with its rarity, makes its diagnosis difficult. We present two cases of pelvic actinomycosis in females with intrauterine contraceptive devices (IUCD) in situ, and stress the need to consider this diagnosis when pelvic neoplasia or inflammatory disease are suspected. A 46-year-old female was admitted with a 4 day history of colicky lower abdominal pain, diarrhoea, anorexia, “anal lumps” that were rapidly enlarging and recent weight loss. There was no noteworthy past medical history. An IUCD (Saf- T) had been in place for 15 years. Abdominal examination revealed a firm, fixed, tender lower abdominal mass that was palpable on vaginal and rectal examinations. The cervix appeared normal. A provisional diagnosis of pelvic malignancy was made. Ultrasound examination was performed and the IUCD was noted within the uterus (Fig. 1). The adnexae and outlines of the uterus were obscured and hypoechoic areas around the uterus were thought to represent fixed bowel loops. A discrete mass could not be demonstrated. Examination under anaesthesia revealed a fixed pelvis. Sigmoidoscopy was performed, but the scope could not be passed beyond 10cm. The rectal mucosa appeared normal. The IUCD was removed and dilatation and curettage performed. A computed tomographic (CT) scan (Fig. 2) showed generalized soft-tissue thickening throughout most of the pelvis with obliteration of the tissue planes around the rectum, uterus and posterior aspect of the bladder.

This publication has 9 references indexed in Scilit: