Annals of Coloproctology

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Benign proctology,Rare disease & stoma

Perianal Actinomycosis: A Surgeon’s Perspective and Review of Literature: Alexios Dosis, Atia Khan, Henrietta Leslie, Sahar Musaad, Adrian Smith; Ann Coloproctol. 2021;37(5):269-274. Published online October 29, 2021; DOI: https://doi.org/10.3393/ac.2021.00332.0047

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Actinomycosis is a serious suppurative, bacterial infection caused by the gram-positive anaerobic Actinomyces species. Primary perianal actinomycosis is rare and challenging for the colorectal surgeon. We aimed to present our experience and compare this with available literature. All patients with isolated Actinomyces on microbiology reports, between January 2013 and February 2021, were identified and reviewed. Data collection was retrospective based on electronic patient records. The site of infection and treatment strategy were examined. Perianal cases were evaluated in depth. All publications available in the literature were interrogated. Fifty-nine cases of positive actinomycosis cultures were reviewed. Six cases of colonization were excluded. Actinomyces turicensis was the most common organism isolated. Five cases of perianal actinomycosis were identified requiring prolonged antibiotic and surgical therapy. Twenty-one studies, most case reports, published since 1951 were also reviewed. Diagnosis of perianal actinomycosis may be challenging but should be suspected particularly in recurrent cases. Prolonged bacterial cultures in anaerobic conditions are necessary to identify the bacterium. An extended course of antibiotic therapy (months) is required for eradication in certain cases.

Citations

Citations to this article as recorded by

Actinomyces Species As Emerging Pathogens: An Observational Study of Clinical Infections and Microbiological Implications
Abraham A Ayantunde, Joanne Kiang, Nadeem S Raja, Javeed Ahmed, Anjali Sanghera, Saumya Venkatesha, Andrew C Ekwesianya
Cureus.2025;[Epub] CrossRef
Imaging of perineal suppurations: a pictorial essay
Mohamed Amine Haouari, Chloé Gallégo, Vincent de Parades, Charlotte Fite, Caroline Touloupas, Alexandre Delpla, Isabelle Bouley-Coletta, Marc Zins
Abdominal Radiology.2025;[Epub] CrossRef
Skin and Soft Tissue Actinomycosis in Children and Adolescents
Salih Demirhan, Erika Orner, Wendy Szymczak, Philip J. Lee, Margaret Aldrich
Pediatric Infectious Disease Journal.2024; 43(8): 743. CrossRef
Colonic actinomycosis masquerading a cancer resulting complete bowel obstruction-a case report
Lilamani Rajthala, Santosh Sirpaili, Krishna Mohan Adhikari
International Journal of Surgery Case Reports.2024; 125: 110563. CrossRef
Letter to the Editor: Actinomyces turicensis Causing Fournier Gangrene
Kaiying Wang, Thomas Zheng Jie Teng, Vishal G. Shelat
Surgical Infections.2022; 23(4): 411. CrossRef
Fungal perianal abscess as the initial presentation of disseminated coccidioidomycosis
Christian Olivo-Freites, Oscar E. Gallardo-Huizar, Christopher J. Graber, Kevin Ikuta
IDCases.2022; 30: e01636. CrossRef

Case Reports

Malignant disease,Benign diesease & IBD,Rare disease & stoma

Actinomycosis of the Appendix Mimicking Cecal Tumor Treated by Single-Port Laparoscopic Approach: In Soo Cho, Sung Uk Bae, Hye Ra Jung, Kyung Sik Park, Woon Kyung Jeong, Seong Kyu Baek; Ann Coloproctol. 2021;37(2):125-128. Published online March 16, 2020; DOI: https://doi.org/10.3393/ac.2019.08.10.1

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Abstract PDF

Actinomycosis is an inflammatory disease with various clinical presentations including inflammation and formation of masses. There are several reports suggesting the infiltrative mass-like nature of actinomycosis that is misunderstood as a tumor. A 39-year-old male clinically presented with a fungating mass-like lesion during colonoscopy for healthcare screening. Biopsy was performed for the lesion, and chronic inflammation was diagnosed. Abdominal computed tomography (CT) suggested severe edematous changes in the appendix with an appendicolith, suspected chronic inflammation, and wall thickening of the cecal base, but malignancy could not be definitively ruled out. The patient underwent a laparoscopic single-port cecectomy based on the possibility of cecal cancer. The final biopsy was diagnosed as actinomycosis, and the patient was prescribed antibiotics and showed no recurrence in the follow-up CT scan. We present this rare case of mass-like appendiceal actinomycosis treated with the single-port laparoscopic method.

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Appendiceal actinomycosis mimicking malignant tumor: a rare case report
Nathan Khabyeh-Hasbani, Sivan Zino, Elena Dima, Shmuel Avital
Annals of Medicine & Surgery.2024; 86(2): 1076. CrossRef
Laparoscopic Cecectomy for Diseases of the Appendix and Cecum
Muharrem Oner, Maher A. Abbas
Journal of Coloproctology.2023; 43(04): e256. CrossRef
Appendiceal actinomycosis presenting as acute appendicitis: A diagnostic and therapeutic challenge
SP Tendulkar, PA Jain, MG Mehta, S George
Journal of Postgraduate Medicine.2023; 69(1): 63. CrossRef
Benign multicystic mesothelioma of appendiceal origin treated by hyperthermic intraperitoneal chemotherapy: A case report
Suk Jun Lee, Ji Hae Nahm, Jeonghyun Kang, Seung Hyuk Baik, Eun Jung Park
International Journal of Surgery Case Reports.2022; 99: 107665. CrossRef
Abdominal Actinomycosis Abscess Presenting as an Isolated Gastrointestinal Pseudotumor
Danisa Clarrett, Jennifer Michelle Ray, Jason R. Taylor
ACG Case Reports Journal.2021; 8(11): e00672. CrossRef

Malignant disease

Abdominopelvic Actinomycosis Mimicking Peritoneal Carcinomatosis: A Case Report: Sungjin Kim, Sung Il Kang, Sohyun Kim, Min Hye Jang, Jae Hwang Kim; Ann Coloproctol. 2020;36(6):417-420. Published online November 13, 2019; DOI: https://doi.org/10.3393/ac.2019.11.07

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3 Citations

Abstract PDF

Actinomycosis is a rare chronic bacterial infection primarily caused by Actinomyces israelii. A 47-year-old woman presented to our clinic with a 1-week history of lower abdominal pain. Preoperative imaging studies revealed multiple peritoneal and pelvic masses suggestive of malignancy. The primary tumor could not be identified despite further endoscopic and gynecological evaluation. On exploration for tissue confirmation, excisional biopsies from multiple masses were performed because complete excision was not possible. Histopathological examination confirmed actinomycosis with multiple abscesses, and the patient was treated with antibiotics. We present a case of disseminated peritoneal actinomycosis that mimicked malignant peritoneal carcinomatosis on imaging studies.

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Carcinomatosis peritoneal, como medirla
A. Mesa Álvarez, M. da Silva Torres, A. Fernández del Valle, A. Cernuda García, E. Turienzo Santos, L. Sanz Álvarez
Radiología.2025; 67(4): 101593. CrossRef
How to measure peritoneal carcinomatosis
A. Mesa Álvarez, M. da Silva Torres, A. Fernández del Valle, A. Cernuda García, E. Turienzo Santos, L. Sanz Álvarez
Radiología (English Edition).2025; 67(4): 101593. CrossRef
Abdominopelvic Actinomycosis—The Diagnostic and Therapeutic Challenge of the Most Misdiagnosed Disease
Alin Mihai Vasilescu, Eugen Târcoveanu, Cristian Lupascu, Mihaela Blaj, Corina Lupascu Ursulescu, Costel Bradea
Life.2022; 12(3): 447. CrossRef

Original Article

Diagnosis and Management of a Cryptoglandular Actinomycotic Fistula-in-Ano: An Update on 7 New Cases and a Review of the Literature: Axel Egal, Isabelle Etienney, Heym Beate, Jean Francois Fléjou, Charles André Cuenod, Patrick Atienza, Pierre Bauer; Ann Coloproctol. 2018;34(3):152-156. Published online June 30, 2018; DOI: https://doi.org/10.3393/ac.2017.07.23

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Purpose
Primary anal actinomycosis of cryptoglandular origin, a rare cause of anal suppurative disease, requires specific management to be cured. The aims of this retrospective study were to describe clinical, morphological, and microbiological features of this entity and to evaluate management practices for new cases observed since 2001.
Methods
This was a retrospective case series conducted at the Diaconesses-Croix Saint-Simon Hospital in Paris.
Results
From January 2001 to July 2016, 7 patients, 6 males and 1 female (median, 49 years), presenting with an actinomycotic abscess with a cryptoglandular anal fistula were included for study. The main symptom was an acute painful ischioanal abscess. One patient exhibited macroscopic small yellow granules (“sulfur granules”), another “watery pus” and a third subcutaneous gluteal septic metastasis. All patients were overweight (body mass index ≥ 25 kg/m²). Histological study of surgically excised tissue established the diagnosis. All the patients were managed with a combination of classical surgical treatment and prolonged antibiotic therapy. No recurrence was observed during follow-up, the median follow-up being 3 years.
Conclusion
Actinomycosis should be suspected particularly when sulfur granules are present in the pus, patients have undergone multiple surgeries or suppuration has an unusual aspect. Careful histological examination and appropriate cultures of pus are needed to achieve complete eradication of this rare, but easily curable, disease.

Citations

Citations to this article as recorded by

Skin and Soft Tissue Actinomycosis in Children and Adolescents
Salih Demirhan, Erika Orner, Wendy Szymczak, Philip J. Lee, Margaret Aldrich
Pediatric Infectious Disease Journal.2024; 43(8): 743. CrossRef
Development of a new patient-reported outcome measure for complex cryptoglandular fistulas (20-Item complex cryptoglandular fistula questionnaire™): a qualitative study
Jeffrey D. McCurdy, Patrick Crooks, Chad Gwaltney, Robert Krupnick, Kathy-Ann Cadogan, Chitra Karki
Journal of Patient-Reported Outcomes.2024;[Epub] CrossRef
Perianal Actinomycosis: A Surgeon’s Perspective and Review of Literature
Alexios Dosis, Atia Khan, Henrietta Leslie, Sahar Musaad, Adrian Smith
Annals of Coloproctology.2021; 37(5): 269. CrossRef

Case Reports

Pilonidal Abscess Associated With Primary Actinomycosis: Han Boon Oh, Mohamad Hashir Abdul Malik, Chris Hang Liang Keh; Ann Coloproctol. 2015;31(6):243-245. Published online December 31, 2015; DOI: https://doi.org/10.3393/ac.2015.31.6.243

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6 Citations

Abstract PDF

Pilonidal disease in the sacrococcygeal region usually presents as abscesses, recurrent inflammation, cellulitis or fistula tracks. However, few reports on actinomycosis affecting pilonidal sinuses have been published. We report a case of a 25-year-old woman who presented with a pilonidal abscess who underwent surgical drainage and debridement. Pus from the pilonidal abscess was sent for microbiology, which grew actinomyces turicensis associated with prevotella bivia and peptostreptococci. She was treated with oral amoxicillin-clavulanate after surgical drainage for one week and recovered well. Actinomycosis associated with pilonidal abscesses, though uncommon, should be recognized and can be satisfactorily treated with a combination of surgical drainage and antibiotics.

Citations

Citations to this article as recorded by

Brain abscess caused by Actinomyces turicensis in a non-immunocompromised adult patient: a case report and systematic review of the literature
Alessandra Imeneo, Lorenzo Vittorio Rindi, Andrea Di Lorenzo, Rosario Alessandro Cavasio, Pietro Vitale, Ilaria Spalliera, Mario Dauri, Daniele Guerino Biasucci, Ilaria Giuliano, Cartesio D’Agostini, Silvia Minelli, Maria Cristina Bossa, Anna Altieri, Mas
BMC Infectious Diseases.2024;[Epub] CrossRef
Skin and Soft Tissue Actinomycosis in Children and Adolescents
Salih Demirhan, Erika Orner, Wendy Szymczak, Philip J. Lee, Margaret Aldrich
Pediatric Infectious Disease Journal.2024; 43(8): 743. CrossRef
Cutaneous Actinomycosis of the Perineum in an Immunocompetent Man
Jeffrey A. Sanford, Walter L. Rush, Mary K. Klassen-Fischer, Jill I. Allbritton
The American Journal of Dermatopathology.2022; 44(4): 272. CrossRef
Pleural empyema caused by Actinomyces turicensis
Apostolos C. Agrafiotis, Ines Lardinois
New Microbes and New Infections.2021; 41: 100892. CrossRef
Actinomycosis of the Appendix Mimicking Cecal Tumor Treated by Single-Port Laparoscopic Approach
In Soo Cho, Sung Uk Bae, Hye Ra Jung, Kyung Sik Park, Woon Kyung Jeong, Seong Kyu Baek
Annals of Coloproctology.2021; 37(2): 125. CrossRef
Actinomyces turicensis parapharyngeal space infection in an immunocompetent host: first case report and review of literature
Ayla Tabaksert, Ravi Kumar, Veena Raviprakash, Rajeev Srinivasan
Access Microbiology .2021;[Epub] CrossRef

Actinomycosis of the Appendix: A Case Report.: Jee, Sung Bae , Jang, Ki Seok , Kim, Sung Ho , Kim, Chul Joong; J Korean Soc Coloproctol. 2010;26(3):233-237.; DOI: https://doi.org/10.3393/jksc.2010.26.3.233

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4 Citations

Abstract PDF

Actinomycosis is an uncommon disease caused by actinomycoses, which is a normal flora in the human mucosal membrane. It is difficult to diagnose pre- and intra-operatively and requires long-term use of antibiotics even after surgery. Especially, abdominal actinomycosis is frequently misdiagnosed as a tumor, diverticulitis, chronic inflammatory disease, or other infectious disease preoperatively. Thus, we report the case of a 21-yr-old male patient who was thought to have acute appendicitis and who underwent a cecal wedge resection, including the appendix, with the assistance of laparoscopy for appendiceal actinomycosis.

Citations

Citations to this article as recorded by

Appendiceal actinomycosis mimicking malignant tumor: a rare case report
Nathan Khabyeh-Hasbani, Sivan Zino, Elena Dima, Shmuel Avital
Annals of Medicine & Surgery.2024; 86(2): 1076. CrossRef
Actinomycosis of the Appendix Mimicking Cecal Tumor Treated by Single-Port Laparoscopic Approach
In Soo Cho, Sung Uk Bae, Hye Ra Jung, Kyung Sik Park, Woon Kyung Jeong, Seong Kyu Baek
Annals of Coloproctology.2021; 37(2): 125. CrossRef
A Case of Esophageal Actinomycosis without Treatment in an Immunocompetent Patient
Gyung Eun Kim, Yong-Jun Choi, Jin-Seok Park, Yong Woon Shin, Jee-Young Han
The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2014; 14(1): 67. CrossRef
A Case of Esophageal Actinomycosis in a Patient with Normal Immunity
Hyun Soo Kim, Jong Woon Cheon, Min Su Kim, Chang Kil Jung, Kyung Rok Kim, Jae Won Choi, Dong Woo Kang, Sun Young Kim
The Korean Journal of Gastroenterology.2013; 61(2): 93. CrossRef

Original Article

Pelvic Actinomycosis: Is It Possible to Diagnose Preoperatively?.: Hwang, Hong Pil , Lee, Min Ro , Kim, Jong Hun; J Korean Soc Coloproctol. 2007;23(6):437-440.; DOI: https://doi.org/10.3393/jksc.2007.23.6.437

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Abstract PDF

PURPOSE
Pelvic actinomycosis is a rare infection which presents difficulty in establishing a correct preoperative diagnosis. The aim of this study is to find diagnostic clues for pelvic actinomycosis preoperatively.
METHODS
A retrospective analysis performed at Chonbuk National University Hospital identified 9 patients with a diagnosis of pelvic actinomycosis from 1998 to 2006.
RESULTS
All patients were women with a history of intrauterine device (IUD) use. Abdominal pain (7 cases), palpable mass (3 cases), defecation difficulty (3 cases) and leucorrhea (2 cases) were the main presenting complaints. The median duration of presenting symptoms was 78 days (range: 10~365 days). The median duration of using an IUD unchanged was 11 years (range: 4~30 years). A correct diagnosis was made in 3 patients (33%) without exploration. All patients were treated with antibiotics after pathologic diagnosis. There was no recurrence.
CONCLUSIONS
It is very difficult to diagnose pelvic actinomycosis preoperatively. Howere, if a mass or a pelvic abscess is found in women with an IUD that has been unchanged for a long time, pelvic actinomycosis should be suspected to avoid unnecessary exploration.

Citations

Citations to this article as recorded by

A Case of Actinomycotic Thyroiditis in an Adult with Piriform Sinus Fistula
Hyun Ju Choi, Bo Won Kim, Min Ji Shin, Bo Kwang Choi, Ji Hyun Kang, Yun Kyung Jeon, Sang Soo Kim, Bo Hyun Kim, In Ju Kim, Yong Ki Kim
Endocrinology and Metabolism.2012; 27(3): 222. CrossRef
Actinomycosis of the Appendix: A Case Report
Sung Bae Jee, Ki Seok Jang, Sung Ho Kim, Chul Joong Kim
Journal of the Korean Society of Coloproctology.2010; 26(3): 233. CrossRef
A Case of Adrenal Actinomycosis that Mimicked a Huge Adrenal Tumor
Eui Joo Kim, Hyon Seung Yi, Inku Yo, Sanghui Park, Kyoung Min Kim, Yoon Soo Park, Sihoon Lee, Yeun Sun Kim, Ie Byung Park
Endocrinology and Metabolism.2010; 25(2): 147. CrossRef
Preoperative Diagnosis and Medical Treatment of Pelvic Actinomycosis
Hong Jue Lee, Su Jin Lee, Young Jae Kim, Sung Hee Kim, Jung Han Lee, Seung Ryoung Kim, Sam Hyun Cho
Journal of Bacteriology and Virology.2008; 38(2): 89. CrossRef

Case Report

A Case of Actinomycosis of the Greater Omentum.: Chae, Gooy Hun , So, Byung Jun , Lee, Jeong Kyun , Yun, Ki Jung , Lee, Kyung Keun; J Korean Soc Coloproctol. 1999;15(2):145-149.

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Abstract PDF: Actinomycosis is a chronic suppurative bacterial infection produced by Actinomyces israeli. The three major clinical presentation include the cervicofacial, thoracic, and abdominal regions. Abdominal actinomycosis is a rare entity which presents some difficulty in establishing a correct preoperative diagnosis. The diagnosis is usually based on histologic demonstration of sulfur granules in pus or surgically resected specimen. Recently, authors experienced a case of actinomycosis of the greater omentum in 38-years old woman. The patient underwent surgery under the impression of periappendiceal abscess. A 6cm sized firm mass was noted in the transverse colon. Histologically the mass was composed of fibroinflammatory mass with multiple actinomycosis granules.

Original Article

The Colonic Obstruction Due to Actinomycosis.: Lee, Ryung Ah , Han, Ho Seong , Kim, Ok Young; J Korean Soc Coloproctol. 1998;14(3):649-654.

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Abstract PDF: Abdominal actinomycosis is very rare infectious disease and seldom reported as a cause of abdominal mass. This disease is diagnosed by pathologic findings and culture result but it is very difficult to differentiate with other granulomatous illammatory disease, diverticular disease, malignancy, etc. The radiologic findings were non-specific and CT scan revealed the inflammatory mass with multiple small abscesses and fibrous change. The treatment of choice for actinomycosis is medical treatment with penicillin but surgical intervention may be needed when complication such as obstruction, fistula formation, abscess formation develop. We report a patient with abdominal actinomycosis that presented with transverse colonic obstruction and severe abdominal wall inflammation. This patient had no past operative history but got intrauterine contraceptive devices during last 10 years. We treated this patient by surgical resection and antibiotic therapy.

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