Case Report
Copyright ©2009 Baishideng. All rights reserved.
World J Gastrointest Surg. Nov 30, 2009; 1(1): 62-64
Published online Nov 30, 2009. doi: 10.4240/wjgs.v1.i1.62
Actinomycosis of the sigmoid colon: A case report
Antonio Privitera, Charanjit Singh Milkhu, Vivek Datta, Manuel Rodriguez-Justo, Alastair Windsor, Charles Richard Cohen
Antonio Privitera, Charanjit Singh Milkhu, Vivek Datta, Alastair Windsor, Charles Richard Cohen, Department of Surgery, University College London Hospitals, London NW1 2BU, United Kingdom
Manuel Rodriguez-Justo, Histopathology Department, Royal Free & University College Medical School, Rockefeller Building, London WC1E 6JJ, United Kingdom
Author contributions: All authors have participated in the perioperative treatment of the patient, diagnosis and follow-up.
Correspondence to: Dr. Antonio Privitera, MD, PhD, MRCS, Department of Surgery, University College London Hospitals, London NW1 2BU, United Kingdom.
Telephone: +44-759-5423060 Fax: +44-120-6742030
Received: July 15, 2009
Revised: September 15, 2009
Accepted: September 22, 2009
Published online: November 30, 2009

Abdominal actinomycosis is a chronic suppurative infection caused by Actinomyces species. The ileo-cecal region is most commonly affected, while the left side of the colon is more rarely involved. The infection has a tendency to infiltrate adjacent tissues and is therefore rarely confined to a single organ. Presentation may vary from non specific symptoms and signs to an acute abdomen. A computed tomography scan is helpful in identifying the inflammatory process and the organs involved. It also allows visual guidance for percutaneous drainage of abscesses, thus aiding diagnosis. Culture is difficult because of the anaerobic character and slow growth of actinomycetes. Colonoscopy is usually normal, but may shows signs of external compression. Preoperative diagnosis is rare and is established only in less than 10% of cases. In uncomplicated disease, high dose antibiotic therapy is the mainstay of treatment. Surgery is often performed because of a difficulty in diagnosis. Surgery and antibiotics are required in the case of complicated disease. Combined medical and surgical treatment achieves a cure in about 90% of cases. The authors report a case of sigmoid actinomycosis where diagnosis was made from the histology, and a review of the literature is presented.

Keywords: Abdominal pain, Actinomycosis, Gram-positive bacteria, Sigmoid colon, Sulfur