A case of actinomycosis involving the pelvic cavity is reported. The patient had a pelvic mass clinically and radiographically. Barium enema examination showed a mass with extrinsic compression and fixed narrowing of the rectum with mucosal irregularity. A computed tomographic scan showed a pelvic mass displacing the rectum.
PIP: In the past Actinomycosis has been associated with diverticular disease of the colon, abdominal surgery, cholecystitis, and penetrating trauma. Recent reports have demonstrated an increased incidence in women using IUDs. Such a case is presented. a 40-year-old woman experienced lower abdominal pain and a 20 pound weight loss over a 2 month period. The patient had had an IUD (a Dalkon shield) placed 7 years previously and had not sought medical attention since then. Pelvic examination revealed an IUD in place and an 8 cm mass fixed to the left side wall and displacing the rectum. The IUD was removed after the pelvic examination. Laboratory studies were all within normal limits except for mild anemia. A computed tomographic scan of the pelvis showed a left hydroureter, an 8 cm pelvic mass with left side wall extension, and displacement of the rectum to the right. A barium enema examination showed fixed narrowing of the rectum and mucosal irregularity. A fine needle aspiration biopsy showed endometritis and frank pus with the presence of Actinomyces. Surgery confirmed these findings. The patient responded to antibiotic therapy after surgery and did well. The colonization of the vagina, cervix, and uterus by Actinomyces and complications such as tubo-ovarian and pelvic abscesses have been reported in IUD users. 1 study reported Actinomyces in as many as 25% of IUD users, although all patients in that study were asymptomatic. In addition, this group had an increased incidence of abnormal pap smears, which may add a confusing note in the event of a pelvic mass. The association if IUD use and abscess appears increased in those patients who have had the same iud in place for more that 2 years, although the complication has been reported only 2 1/2 months following IUD insertion. Actinomycosis is a diagnosis seldom made before biopsy or surgery. Culture of the organism is essential and the diagnosis is best made using immunofluorescent staining of formaldehyde-fixed, paraffin-embedded tissue. This needle biopsy can provide a quick diagnosis. Therapy includes high dose penicillin, to which the disease responds quickly, and incision and drainage if necessary. Prompt diagnosis and adequate treatment reduce the morbidity of dissemination and of chronic infection.