Abdomino-pelvic actinomycosis of urachal remnant mimicking lower abdominal tumour

Awe J.A.A¹ and Soliman AM²

¹Associate Professor of Surgery and Consultant General Surgeon, Department of Surgery, College of Health Sciences, Igbinedion University, Okada, Edo State. Nigeria.

²Senior Surgical Registrar, Northern Area Armed Forces Hospital, King Khalid Military City, P.O. Box 10018, Hafr Al-Batin 31991, Saudi Arabia.

*Corresponding Author E-mail: doset2007@yahoo.com

Accepted 18 November, 2013

Abstract

Abdominal-pelvic actinomycosis constitutes three percent (3%) of all human actinomycotic infections. It is usually insidious, and is one of the great imitators in clinical practice, particularly when it occurs in abdominal cavity and one is struck by the frequency with which actinomycotic lesions are diagnosed to be diverticulitis, abscesses, inflammatory bowel disease or even a neoplasm. We report a case of urachal actinomycosis that presented with a progressively enlarging infraumbilical mass associated with infraumbilical discharge. Ultrasound and CT scan examinations of the abdomen and pelvis revealed an heterogenous mass extending through and through intraperitoneal to extraperitoneal planes with bowel loops adherent to this mass on its intra-peritoneal side. Gas filled spaces were also apparent within the mass. A provisional differential diagnosis of an inflammatory bowel disease, tumour of abdominal wall, chronic infections such as tuberculosis or actinomycosis was made. All the involved bowels with partial cystectomy and involved abdominal wall were resected. The pathologic examination revealed actinomycosis. The patient was treated with penicillin and no recurrence was noted on postoperative follow-up. The case is therefore presented to raise the awareness of this rare condition, to be included in the differential diagnosis of an abdominal or abdomino-pelvic mass.

Keywords: Actinomycosis, Abdomen, Pelvis, Tumour.