title: Abdominal actinomycosis mimicking acute appendicitis.
abstract: A 52-year-old Hispanic woman presented to the emergency department, reporting worsening sharp lower right quadrant abdominal pain for 3 days. CT of the abdomen and pelvis showed evidence of inflammation in the peritoneal soft tissues adjacent to an enlarged and thick-walled appendix, an appendicolith, no abscess formation and a slightly thickened caecum consistent with acute appendicitis. During laparoscopic appendectomy, the caecum was noted to be firm, raising suspicion of malignancy. Surgical oncology team was consulted and open laparotomy with right hemicolectomy was performed. Pathology reported that the ileocaecal mass was not a malignancy but was, rather, actinomycosis. The patient was discharged after 10 days of intravenous antibiotics in the hospital, with the diagnosis of abdominal actinomycosis. Although the original clinical and radiological findings in this case were highly suggestive of acute appendicitis, abdominal actinomycosis should be in the differential for right lower quadrant pain as it may be treated non-operatively.
authors.affiliation: Department of Surgery, Texas Tech University Health Sciences Center School of Medicine, Amarillo, Texas, USA.
authors.forename: Robert Joseph
authors.initials: RJ
authors.lastname: Conrad
authors.affiliation: Department of Surgery, Texas Tech University Health Sciences Center School of Medicine, Amarillo, Texas, USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Riela
authors.affiliation: Department of Surgery, Texas Tech University Health Sciences Center School of Medicine, Amarillo, Texas, USA.
authors.forename: Ravi
authors.initials: R
authors.lastname: Patel
authors.affiliation: Department of Surgery, Texas Tech University Health Sciences Center School of Medicine, Amarillo, Texas, USA.
authors.forename: Subhasis
authors.initials: S
authors.lastname: Misra
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000196:Actinomycosis / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery; D000208:Acute Disease; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001062:Appendectomy; D001064:Appendicitis / Q000175:diagnosis*; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D005767:Gastrointestinal Diseases / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery; D006801:Humans; D008875:Middle Aged; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents