Intrauterine device-associated actinomycosis simulating pelvic malignancy
Spagnuolo, P.J.; Fransioli, M.
American Journal of Gastroenterology 75(2): 144-147
1981
ISSN/ISBN: 0002-9270 PMID: 7234838 Document Number: 182099
Pelvic actinomycosis of the female genital tract is an indolent suppurative inflammation involving the adnexal tissues and occasionally, the endometrium. It is becoming increasingly associated with IUD use, and its diagnosis is seldom made preoperatively. This report presents a case of widespread, unrecognized pelvic actinomycosis involving the rectum in an IUD-wearer. It also illustrates the difficulty in diagnosing and managing this disorder. A 43-year old woman admitted to the University Hospitals presented with a severe process which mimicked a pelvic malignancy. 8 months prior to admission, she had an IUD in place for 11 years removed due to irregular menstrual bleeding; dilatation and curettage revealed tissues associated with acute endometritis and several Actinomyces colonies were observed in a cervical smear. At the University Hospitals, diagnosis of pelvic actinomycosis was not suspected preoperatively. Exploratory laparotomy, hysterectomy, and bilateral salpingo-oophorectomy revealed no gross evidence of malignancy. Modified abdominoperitoneal resection was performed, leaving a sigmoid colostomy in place. Multiple histologic sections necessitated the confirmation of the diagnosis of actinomycosis. Presence of bilateral salpingo-oophoritis and the fact that Actinomyces colonies were observed in cervical smear strongly indicate that the initial focus of infection was related to the IUD rather than an intestinal site. The patient recovered uneventfully and was well at a 3-month follow-up. This case demonstrates also the progression of suppurative disease despite prior removal of IUD. Pelvic actinomycosis should be considered in patients with IUD, or those who have had them removed recently and those who are experiencing abdominal pain, recurrent vaginal bleeding, and adnexal masses.