title: Pelvic actinomycosis masquerading as an acute abdomen from a small bowel perforation.
abstract: Pelvic actinomycosis is an extremely rare disease which may complicate long-term intrauterine contraceptive device (IUCD) use. Its timely recognition is important as clinical and radiological signs may mimic other intra-abdominal pathology and lead to radical and unnecessary surgery. We report a 50-year-old woman with pelvic actinomycosis resulting from a neglected intrauterine device, which was left in place for 20 years. The signs and symptoms at presentation were consistent with acute peritonitis from a perforated viscus. A perforated segment of the small bowel was suspected intraoperatively and resection was performed. The diagnosis was only revealed on subsequent histopathological examination of the surgical specimen. A high index of suspicion for this rare but devastating condition must be maintained in any woman with an IUCD and who presents with a surgical abdomen. Diligence in replacing IUCDs at recommended intervals and adherence to "missing threads" protocols may prevent these sequelae.
authors.affiliation: Department of Obstetrics and Gynaecology, Singapore General Hospital, Outram Road, Singapore 169608. devendra.kanagalingam@sgh.com.sg
authors.forename: K
authors.initials: K
authors.lastname: Devendra
authors.forename: C M
authors.initials: CM
authors.lastname: Chen
mesh_terms: D000006:Abdomen, Acute / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D000196:Actinomycosis / Q000175:diagnosis / Q000209:etiology*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007416:Intestinal Perforation / Q000150:complications / Q000209:etiology; D007421:Intestine, Small / Q000382:microbiology* / Q000601:surgery; D007434:Intrauterine Devices / Q000009:adverse effects / Q000382:microbiology*; D008875:Middle Aged; D000292:Pelvic Inflammatory Disease / Q000150:complications / Q000209:etiology; D010538:Peritonitis / Q000209:etiology*