Actinomycosis complicating sigmoid diverticular disease: a case report
© Vodovnik and Logishetty; licensee Cases Network Ltd. licensee BioMed Central Ltd. 2009
Received: 5 January 2009
Accepted: 16 February 2009
Published: 10 March 2009
A 63-year-old Caucasian woman was admitted to hospital as hypotensive with abdominal tenderness and vaginal discharge. Laboratory investigations showed microcytic anaemia, low albumin and high white cell count. Computerised tomography scans revealed small bowel dilatation, sigmoid diverticula, ascites and pelvic fluid. The endometrial pipelle was positive and vaginal swab was negative for actinomyces. Post mortem examination revealed widespread sigmoid diverticular disease and bowel perforation with an intense inflammation. Actinomycotic granules were noted in the diverticular inflammatory debris, pelvic abscess and lung sections. Clinical course and histomorphological findings favour the perforating sigmoid diverticular actinomycosis as an origin of the systemic infection.
Abdominal and pelvic infections account for 10-20% of reported cases of actinomycosis. The disease presents typically as a slowly growing mass in the ileo-cecal region and patients usually have a history of bowel surgery or ingestion of foreign bodies [1–3]. We present a case of actinomycosis complicating sigmoid diverticular disease.
Summary of laboratory test results
White cell count
4 - 11
Red Cell Count
3.8 - 5.8
11.0 - 16.5
0.37 - 0.51
RBC Distribution Width
11.8 - 14.8
2.0 - 7.5
1.5 - 4.0
34 - 50
Abdominal actinomycosis has been occasionally reported in the medical literature as a complication of perforated diverticular disease but it is possible that the true incidence is underestimated . Actinomyces require devitalized tissue and a break in the integrity of the mucous membranes to invade, and diverticular disease offers all the conditions for development of infection. Clinical course and histomorphological findings in this case suggest the perforating sigmoid diverticular actinomycosis as an origin of the systemic infection. However, the coexisting endometrial and diverticular actinomycotic disease could not be completely ruled out. Awareness of the possibility of actinomycosis in diverticular disease is important as hematogenous spread can occur at any stage and management of the disease is complex with an uncertain outcome.
As this is a coroner's post mortem case, the consent for publishing this case has been received from HM Coroner. We believe this case report contains a worthwhile clinical lesson which could not be as effectively made in any other way. We expect the patient's next-of-kin not to object to the publication since every effort has been made so that the patient remains anonymous.
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