手术和临床研究档案

ISSN：2576-9537

Case Report

Actinomycosis of the appendix

Lucas Wheatley^1*, Michael Lonne²，詹姆斯·本内特²和Bhavik Patel³

¹MBBS, FRACGP, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
²MBBS，皇家布里斯班和妇女医院，澳大利亚昆士兰州布里斯班
³MBBS, FRACS Royal Brisbane and Women’s Hospital, Brisbane Queensland, Australia

*通讯地址：Lucas Wheatley, MBBS, FRACGP, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia, Tel: +61 412 754 325; Email: lucas.wheatley@health.qld.gov.au

日期：提交：03 October 2018;Approved:2018年10月16日;发布：2018年10月17日

How to cite this article:Wheatley L，Lonne M，Bennet J，PatelB。附录的放线菌病。Arch Surg Clin Res。2018;2：029-030。doi：10.29328/journal.ascr.1001020

Copyright License:© 2018 Wheatley L, et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

一名40岁的妇女向急诊科展示了她的右fossa慢性腹痛的急性。在历史上，她的疼痛已经存在了6个月以上，此前已经通过超声检查，CT和诊断性腹腔镜进行了研究。在过去的两周中，她的痛苦急剧恶化。这与两天的腹泻有关，但没有其他全身症状。她的病史对他克莫司，硫唑嘌呤和泼尼松的肾脏移植物进行免疫抑制很重要[1]。她的腹部检查除了右窝窝和可触摸的非倾向肾移植外，她的腹部检查是无关紧要的。她的炎症标志物，电解质和尿液显微镜不明显。她通过超声检查进一步研究了她的移植和非对比度CT（由于对比过敏）。她的CT在阑尾腔内显示出一种粪便石，但没有急性阑尾炎的迹象（图1）。由于持续的疼痛和CT发现粪便石，她被服用进行腹腔镜进行阑尾切除术。

Intraoperatively she had a macroscopically normal appendix and no other cause for the patients symptoms could be identified. A laparoscopic appendicectomy was performed with no complications. Her pain persisted postoperatively and she was discharged post operative day two with analgesia. Histology subsequently revealed actinomyces-like organisms consistent with actinomycosis of the appendix (Figure 2). Her case was discussed with the Infectious diseases team and she was started on an extended course of oral amoxicillin [2].

Actinomycosis is a rare chronic infection caused by actinomyces, a gram positive facultative anaerobic organism. Actinomyces is a ubiquitous soil organism but also normally colonises the human oral cavity, upper respiratory tract, gastrointestinal tract and vagina. Actinomycosis occurs when normal host barriers are disrupted allowing for disseminated infection. Actinomycosis most commonly affects the cervicofacial, thoracic and abdominal regions. Abdominal actinomycosis may affect any organ but is most prevalent at the ileocolic region with most cases diagnosed following appendicectomy for presumed appendicitis. Although most frequently confined to isolated case reports and case series, several larger studies have estimated the prevalence of actinomycosis at 0.02-0.06% of cases of appendicitis. The clinical presentation is varied, ranging from acute appendicitis or abscess formation to infiltrative ileocaecal masses [3]. Diagnosis is confirmed histologically with demonstration of granulomatous inflammation, extensive fibrosis, sulphur granules and identification of actinomyces organisms. Treatment usually consists of high dose intravenous penicillin followed by a prolonged oral course often for 6 months to ensure eradication of any residual infection and prevent disseminated disease.

1. Lee Sy，Kwon HJ，Cho JH，Oh JY，Nam KJ等。附录的放线菌病模仿阑尾肿瘤：病例报告。世界j胃肠道。2010;16：395-397。参考：https://goo.gl/mdd1aw
2. Lisa-Gracia M, Martin-Rivas B, Pajaron-Guerrero M, Arnaiz-Garcia A. Abdominal actinomycosis in the last 10 years and risk factors for appendiceal actinomycosis: review of the literature. Turk J Med Sci. 2017; 47: 98-102. Ref.:https://goo.gl/FLcTkt
3. Liu K, Joseph D, Lai K, Kench J, Ngu MC, et al. Abdominal actinomycosis presenting as appendicitis: two case reports and review. Journal of surgical case reports. J Surg Case Rep. 2016; 2016. Ref.:https://goo.gl/mh65Nd