A CASE OF ABDOMINAL ACTINOMYCOSIS CURED BY PENICILLIN ANTIBIOTICS, DIAGNOSED BY HISTOPATHOLOGICAL EXAMINATION AFTER APPENDECTOMY

Abstract

A 61-year-old man was seen at our hospital because of right lower abdominal pain that had persisted for 1 week or longer. Ultrasonographic examination and abdominal CT scan demonstrated a swollen sppendix and a solid mass that included a liquid component was continuous with the appendix. Based on these findings, we diagnosed appendicitis with abscess formation and performed an appendectomy. Laparotomy showed a swollen appendix with a thickened wall, a periappendicular abscess, and retroperitoneum with remarkable inflammatory thickening and sclerosing, to which the appendix adhered. Although a second-generation cephem antibiotic was administered postoperatively by drip infusion, signs of infection such as fever and pus discharge from the abscess persisted. Because histopathological examination demonstrated abdominal actinomycosis, penicillin antibiotics were administered intramuscularly. Thereafter, symptoms soon improved and the fistula closed in 3 weeks. Penicillin antibiotics were administered orally for 3 months postoperatively, and there has not been any recurrence for 1 year and 8 months.
It is important to suspect actinomycosis and select adequate antibiotics when a case of appendicitis is accompanied by mass formation and shows signs of protracted infection such as pus discharge postoperatively.