title: Large bowel obstruction due to intrauterine device: associated pelvic inflammatory disease.
abstract: Pelvic actinomycosis associated with the use of intrauterine contraceptive devices (IUDs) can mimic pelvic malignancy. Recognizing this rare, but not uncommon complication of IUD use can spare a patient from an extensive surgical procedure. If recognized preoperatively, a simple regimen of antibiotics can be curative; however, if symptomatic, a limited surgical procedure is warranted. We present the case of a 55-year-old woman with a slow, indolent course of partial large bowel obstruction and a history of IUD use for over 20 years. A preoperative CT scan revealed a frozen pelvis mimicking a pelvic malignancy. Exploratory laparotomy revealed a firm, indurated, fibrotic reaction in the pelvis involving the uterus, adnexa, and sigmoid colon. A diverting loop colostomy was performed, and pathology revealed sulfur granules from the extracted IUD that grew Actinomyces. The patient was treated with the appropriate antibiotics, and during the takedown of the colostomy 6 months later the pelvic inflammation was completely resolved. An extensive review of the literature involving actinomycotic abscesses associated with IUD use reveals a limited number of studies reported in the general surgical literature. It behooves the general surgeon to be aware of this unusual case so that the appropriate consultation and treatment can be performed with limited morbidity to the patient.
authors.affiliation: Department of Surgery, St. Francis Medical Center, Trenton, New Jersey, USA.
authors.forename: D
authors.initials: D
authors.lastname: Antonelli
authors.forename: J F
authors.initials: JF
authors.lastname: Kustrup
mesh_terms: D000196:Actinomycosis / Q000175:diagnosis / Q000209:etiology*; D000667:Ampicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000627:therapeutic use; D003125:Colostomy; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology*; D007434:Intrauterine Devices / Q000009:adverse effects*; D007813:Laparotomy; D008795:Metronidazole / Q000627:therapeutic use; D008875:Middle Aged; D000292:Pelvic Inflammatory Disease / Q000382:microbiology*; D010386:Pelvic Neoplasms / Q000175:diagnosis; D010406:Penicillins / Q000627:therapeutic use; D012810:Sigmoid Diseases / Q000209:etiology*; D013407:Sulbactam / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed
chemical_list: D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D010406:Penicillins; D008795:Metronidazole; D000667:Ampicillin; D013407:Sulbactam