[Pelvic actinomycosis: just think of it]

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.