Surgical treatment for unusual presentations of abdominal actinomycosis: two case reports

Abstract

Actinomycosis is a rare chronic disease caused by anaerobic Gram-positive Actinomyces species. These bacteria normally colonize the mouth, colon and urogenital tract and mucosal disruption is necessary to lead to infection. Due to its propensity to mimic other diseases, it is often misdiagnosed. It can mimic other conditions such as tuberculosis and malignancy and a preoperative diagnosis is rarely considered. An early diagnosis needs a high level of clinical suspicion and bacterial cultures in anaerobic conditions are necessary to identify the bacteria. Of the more than 30 species, Actinomyces Israelii is the most common human pathogen and one of the most involved in abdominal actinomycosis. Treatment includes high doses of antibiotic therapy sometimes combined with surgery in the case of complicated disease such as bowel obstruction. The authors report two cases of abdominal actinomycosis presenting with bowel obstruction and bowel perforation by a strange body.