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ACTINOMYCETOMA IN ABDOMINAL CAVITY

D. Bolado López De Andújar1 , D. Fajardo Puig2 , P.B. Guillamot Ruano3 ,

R.E. Medina Quintana3

1 12 de Octubre University Hospital, Faculty of Medicine, UCM; 2 Department of Biochemistry and Molecular Biology, Faculty of Medicine, UCM; 3 General and Gas- trointestinal Surgery Team (Dr. F.J. García Borda), Madrid University Hospital

Introduction: Actinomycosis is a chronic granulomatous infection caused by gram-positive bacilli of the order of Actinomycetales whose estimated inci- dence is 0.3-1 episodes per year per 100,000 patients. It mainly affects males (3:

1) of middle age and its evolution is usually favorable. Its treatment is based on antibiotherapy, and exceptionally in surgery, when it is presented as actinomyce- toma, as is the case shown here.

Methods: This is a 63-year-old woman with a clinical history of sarcoidosis, hypothyroidism and asymptomatic cholelithiasis diagnosed by CT and MRI of a pre-peritoneal soft tissue tumour at infraumbilical level that invades the abdom- inal wall musculature.

Results: Under the diagnosis of suspicion of a tumour in the abdominal cavity, we intervene in a programmed manner, finding a 10x4x4 cm tumour that infiltrates the aponeurosis, rectus abdominis muscles, peritoneum and external face of the bladder dome. A bloc resection of the lesion and repair of the wall is performed by means of an eventroplasty according to the Chevrel technique in the defect of the wall generated in the opening by means of midline laparotomy.

The analysis of the piece resulted in a large inflammatory infiltrate without signs of malignancy, in which microorganisms of the genus Actinomyces are identified.

Conclusions: We are thus faced with an interesting case of an actinomyce- toma, an exceptional and chronic presentation of a bacterial infection that has required surgical treatment, having been successful and favorable.

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