Abdominal actinomycosis: the unexpected disease

Medical Review (Med. pregled), 2025, 61(2), 57-64.

G. Popivanov, A. Zasheva, B. Ilcheva, V. Mihaylov, Ts. Lukanova, M. Konakchieva, M. Tabakov¹, K. Kyosev, V. Mutafchiyski

Military Medical Academy – Sofia
¹ UMHAT “Sv. Iv. Rilski”- Sofia

Abstract. Actinomycosis is an indolent but invasive granulomatous infection caused by Actinomyces spp. and may affect each body part. The work aims to present an illustrative case series and to review the Bulgarian literature. The early diagnosis is important because the antibiotic treatment can help avoid surgery in certain cases or limit the surgery volume. Herein we present three cases. The first is a 22-year-old woman admitted in an elective setting with endoscopic and CT findings suggestive of a tumor of the cecum. Intraoperatively, a firm tumor formation of the cecum involving the base of the appendix and ileocecal valve with a size of 7×5 cm was found, which was managed by right hemicolectomy with uneventful recovery. The second case is a 55-year-old woman admitted in an emergency due to a small bowel ileus. Intraoperatively, a mesenteric tumor mass with a diameter of 10 cm involving an ileal loop was found. The case was managed by small bowel resection. Unfortunately, the patient died from a severe COVID-19 infection on the 5th postoperative day. The third case is a 40-year-old man with a huge liver mass and a septic condition. CT revealed a heterogeneous, polycystic mass of the right liver with a diameter of 19 cm, thrombosis of the right portal branch, ascites, and right pleural effusion. The patient was managed by right trisectionectomy (segments IV-VIII). Three years later, he is free of complaints, with normally functioning liver remnant. A total of 18 papers published in the period 1993-2024, which present 36 cases, were identified in the Bulgarian literature. The localizations were as follows: 16 cases with cervicofacial, 4 with pelvic, 2 with thoracic, and 15 with abdominal actinomycosis. In 60% of them (a total of 20 pts. including the presented cases), the infection was located in the right colon. In 94%, the preoperative diagnosis was a tumor. Approximately 50% of the cases were operated as emergency. In 2/3 of the cases with pelvic actinomycosis, there was a history of intrauterine contraception. The abdominal and pelvic actinomycosis imitates a wide spectrum of diseases. The present series describes the first case of liver actinomycosis in Bulgaria. The analysis of the Bulgarian literature demonstrates almost equal rates of cervicofacial and abdominal actinomycosis. The last is located mainly in the right colon (60%). In 94% of the cases, the preoperative diagnosis was tumor. In most cases, the CT scans demonstrated heterogeneous mass with infiltration of the adjacent tissues.

Key words: abdominal and liver actinomycosis, misdiagnosis, treatment

Address for correspondence: Assoc. Prof. Georgi Popivaniv, MD, Department of Surgery, Military Medical Academy 3 Sv. Georgi Sofiyski Str., 1606 Sofia, е-mail: , GSM: +359 885 521 241, Fax: +359 2 95 26 536; ORCID N: 0000-0001-9618-3187