Dr. Dragos Chichirăugeneral surgery specialist, Arcadia
A 55-year-old patient with a medical history of hypertension and diabetes presented to the Arcadia Multidisciplinary Hospital with abdominal pain syndrome, accompanied by a voluminous deformation of the left hemiabdomen, to which he associated chills and fever that had been evolving for about 2 weeks. The patient tolerated the pain, but was concerned about the enlargement of the abdomen and the suspicion of cancer from a previous consultation.
The patient was referred to the Arcadia Imaging Service, where a abdominal-pelvic computer tomography with contrast materialwhere a giant intraperitoneal fluid collection (in the abdomen), 85 mm/60 mm/50 mm. This abscess also had a accessory collection developed in the abdominal musclesof 140mm/80mm/50mm, which also incorporates part of the small intestine, transverse colon, and large omentum.
The patient was admitted as an emergency in order to carry out the surgical treatment. During the intraoperative exploration, a pseudotumoral formation of the great omentum invading the parietal peritoneum and the rectus abdominis muscle. During surgery the necrotic tissue was removed and the peritoneal abscess and muscle sheath abscess were drained. The intervention had a high degree of difficulty and lasted an hour and a half. The patient remained hospitalized for 5 days, during which the evolution was favorable. After discharge, he presented himself for the postoperative control.
Following the pathological examination, the patient was diagnosed with a rare condition called peritoneal actinomycosis. To date, there are few cases of peritoneal actinomycosis in men described in large surgery services in Romania.
Actinomycoza this is chronic suppurative bacterial infection caused by a bacterium from the Actinomyces family, which is normally found in the oral cavity, digestive tract, urinary tract, bronchi and female genital tract.
Actinomycosis peritoneal (abdominal) can occur when the mucosal barrier is damaged, following abdominal inflammatory processes, gastrointestinal perforations, neoplasias, the presence of foreign bodies in the genitourinary tract (eg intrauterine device). The condition begins with the formation of a thick-walled abscess, which evolves slowly, over weeks or years, into multiple abscesses and fistulas that may affect organs located far from the primary abscess.
The manifestations of abdominal actinomycosis are nonspecific: persistent fever, transit disturbances, abdominal pain, nausea, vomiting, weight loss. The differential diagnosis is difficult because there is no investigation that clearly indicates this condition, the anatomopathological examination being the one that establishes the diagnosis of certainty.
The patient recalled eating fish approximately 2 weeks before the onset of symptoms, feeling at the time that he had swallowed a bone. In this context, there is a possibility that the bone may have punctured his intestine, thus releasing the bacteria from the intestine into the abdomen.
Due to the evolution towards multiple abscesses, the condition presents the risk of recurrence. In order for the healing to be complete, after the surgical intervention the infectious disease doctor prescribes an additional treatment with the objective of completely destroying the bacteria in the abdomen. The treatment is long-term, varying between 4 weeks and 12 months. The patient in question was recommended penicillin treatment for 6 months. After the end of follow-up by the infectious disease doctor, the patient will return to General Surgery for a CT scan.
To schedule a General Surgery consultation, patients have the phone number at their disposal 0232 920, Call Center Arcadia.
2024-03-04 01:02:38
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