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|Year : 1984 | Volume
| Issue : 2 | Page : 133-4
Primary actinomycosis of the anterior abdominal wall (a case report).
Deodhar SD, Shirahatti RG, Vora IM
|How to cite this article:|
Deodhar S D, Shirahatti R G, Vora I M. Primary actinomycosis of the anterior abdominal wall (a case report). J Postgrad Med 1984;30:133
Actinomycosis is a fairly common condition in our country and lesions of the caecum, lung and mandible are well documented. However, primary actinomycosis of the anterior abdominal wall is uncommon and has not been described in standard text books of surgery,, and mycology. We had a case of this type at the King Edward VII Memorial Hospital, Bombay. The extreme rarity of this condition, prompted up to present this report.
V.J.P., a 40 year old male and farmer by occupation was admitted on 16-2-1983 with complaints of recurrent pain in the right side of the abdomen of one year's duration. The pain was accompanied by distension and an ill-defined lump in the abdomen. A year prior to admission, the patient had an episode of acute abdominal pain lasting for 48 hours. This responded to conservative treatment carried out elsewhere. This was followed by the appearance of a lump.
On examination, the patient had a lump, 8 cm x 8 cm in size, at the junction of the right lumbar and right iliac regions. The lump was firm, slightly tender and deep to the abdominal muscles. It was difficult to opine whether the lump was in the parietes or was intraperitoneal. Examination of the rest of the abdomen did not reveal any abnormality.
Routine examination of blood, urine and stools were normal except for the E.S.R., which measured 85 mm at the end of 1 hour (Wintrobe's method). Barium study did not reveal any intestinal pathology.
At exploration under general anaesthesia on 18-3-1983, a firm lump, 8 cm x 8 cm in size was found deep to the right rectus muscle, adherent to the parietal peritoneum. It bulged into the peritoneal cavity and two loops of ileum were minimally adherent to the peritoneal aspect of the lump. These loops were separated and the lump excised with a rim of healthy tissue all around. The wound was closed in layers. The post-operative course was uneventful. The patient was discharged and prescribed tectracycline for 2 weeks. When last seen, he was free of complaints.
Histopathological examination of the mass showed features of chronic suppurative inflammation. The mass consisted of fibrofatty tissue with severe diffuse mononuclear cell infiltration composed of foamy histiocytes, lymphocytes and plasma cells. One area showed a purplish granular mass with eosinophilic tinge at the periphery surrounded by acute inflammatory cells [Fig. 1], Gram's staining of the section showed irregular Gram positive filaments with Gram negative clubs. They were not acid fast, thereby ruling out Nocardia. Since the culture could not be done the exact species of actinomyces could not be determined; however, the histological features were in favour of Actinomyces israeli.
Actinomycosis affect the cervico-facial; thoracic and abdominal regions. In the abdomen, it commonly affects the appendix, caecum, stomach, colon and liver. The primary focus is in the carious teeth or septic tonsils, from which the organism is ingested. When the intestinal mucosa is intact, no lesion arises. If there is breach in the wall, as in perforation, the fungus may escape into the surrounding tissues and form a hard, irregular growth. In our patient, the barium study as well as the findings at operation did not reveal any intestinal or other visceral involvement. Hence, we consider that our patient had primary actinomycosis of the anterior abdominal wall.
We thank the Dean, Seth G.S. Medical College and K.E.M. Hospital, Bombay, for permitting us to publish this case report.
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