A Case of Abdominal Actinomycosis with Sigmoid Colon Fistula, Bladder Fistula and Abdominal Wall Abscess Induced by Intrauterine Contraceptive Device

Abstract

A 53-year-old woman admitted for lower abdominal pain was found to have a large tumor in the lower abdominal wall. The top of tumor had necrosed, leading to fecal discharge. Fecal discharge was also found in urine. Pelvic computed tomography showed a massive lesion in the pelvic space and abscess cavity in the abdominal wall. Colonography showed the leakage of contrast medium from the sigmoid colon. Cystoscopy showed fecal fluid in the bladder. The patient had used an intrauterine contraceptive device for 20 years. Histopathologic examination of the endometrial cavity of uterus showed sulfur granules of actinomycosis. From these findings, the patient was diagnosed as having actinomycosis of the uterus due to the intrauterine contraceptive device. The abdominal abscess was thought to have originated from a sigmoid colon and blad-der fistulas. Because conservative therapy was ineffective, we surgically drained and resected the fistula. The postoperative course was uneventful. The abscess cavity in the abdominal wall disappeared and no recurrent mass has been found in the months since.