- Louis-Michel Wong Kee Song, MD, FRCP(C)
Louis-Michel Wong Kee Song, MD, FRCP(C)
- Associate Professor of Medicine
- Mayo Clinic College of Medicine
- Norman E Marcon, MD, FRCP(C)
Norman E Marcon, MD, FRCP(C)
- Professor of Medicine
- University of Toronto
A number of disorders are associated with lesions in the ileocecal region. Examples frequently encountered in developed countries include colon cancer, Crohn's disease, and, less commonly, infection due to Yersinia enterocolitica and Y. pseudotuberculosis (see related topic reviews). Many other infectious, neoplastic, and drug-related causes of ileocecal lesions have been described.
This topic review will provide an overview of abdominal actinomycosis, which is one of the causes of ileocecal lesions that are frequently considered in specific clinical settings or when more frequent causes have been excluded or are unlikely. The others (including mucoceles, tuberculosis, typhlitis, carcinoid, and lesions due to nonsteroidal antiinflammatory drugs) are discussed separately. (See appropriate topic reviews.)
Actinomycosis is an uncommon, chronic granulomatous disease caused by filamentous, gram-positive, anaerobic bacteria . Actinomyces israelii is the major human pathogen [1,2]. Actinomycosis has a worldwide distribution, affects mostly middle-aged individuals, and is two to four times more common in men [2-4].
Actinomycetes are commensal inhabitants of the oral cavity and intestinal tract  but acquire pathogenicity through invasion of breached or necrotic tissue. As the infection progresses, granulomatous tissue, extensive reactive fibrosis and necrosis, abscesses, draining sinuses, and fistulas are formed .
Infection involving the cervicofacial area is most common (50 percent), followed by abdominal involvement (20 percent) and thoracic involvement (15 to 20 percent) . In abdominal actinomycosis, the appendix and ileocecal region are usually involved [1,6]. The disease tends to remain localized as the infection spreads contiguously, disregarding tissue planes. Lymphadenopathy is not a clinical feature. Hematogenous dissemination is also rare [1,2]. (See "Cervicofacial actinomycosis".)
- Wong VK, Turmezei TD, Weston VC. Actinomycosis. BMJ 2011; 343:d6099.
- Cintron JR, Del Pino A, Duarte B, Wood D. Abdominal actinomycosis. Dis Colon Rectum 1996; 39:105.
- Ferrari TC, Couto CA, Murta-Oliveira C, et al. Actinomycosis of the colon: a rare form of presentation. Scand J Gastroenterol 2000; 35:108.
- Yegüez JF, Martinez SA, Sands LR, Hellinger MD. Pelvic actinomycosis presenting as malignant large bowel obstruction: a case report and a review of the literature. Am Surg 2000; 66:85.
- Dayan K, Neufeld D, Zissin R, et al. Actinomycosis of the large bowel: unusual presentations and their surgical treatment. Eur J Surg 1996; 162:657.
- Piper MH, Schaberg DR, Ross JM, et al. Endoscopic detection and therapy of colonic actinomycosis. Am J Gastroenterol 1992; 87:1040.
- Vyas JM, Kasmar A, Chang HR, et al. Abdominal abscesses due to actinomycosis after laparoscopic cholecystectomy: case reports and review. Clin Infect Dis 2007; 44:e1.
- Ramia JM, Mansilla A, Villar J, et al. Retroperitoneal actinomycosis due to dropped gallstones. Surg Endosc 2004; 18:345.
- Harris LA, DeCosse JJ, Dannenberg A. Abdominal actinomycosis: evaluation by computed tomography. Am J Gastroenterol 1989; 84:198.
- Litt HI, Levine MS, Maki DD, et al. Ileal actinomycosis in a patient with AIDS. AJR Am J Roentgenol 1999; 172:1297.
- Ha HK, Lee HJ, Kim H, et al. Abdominal actinomycosis: CT findings in 10 patients. AJR Am J Roentgenol 1993; 161:791.
- Lee IJ, Ha HK, Park CM, et al. Abdominopelvic actinomycosis involving the gastrointestinal tract: CT features. Radiology 2001; 220:76.
- Higaki S, Matsuura S, Awaya N, et al. A case of colonic actinomycosis difficult to distinguish from advanced colonic carcinoma. Endoscopy 1995; 27:712.
- Yang SH, Li AF, Lin JK. Colonoscopy in abdominal actinomycosis. Gastrointest Endosc 2000; 51:236.
- Kim JC, Ahn BY, Kim HC, et al. Efficiency of combined colonoscopy and computed tomography for diagnosis of colonic actinomycosis: a retrospective evaluation of eight consecutive patients. Int J Colorectal Dis 2000; 15:236.
- Morini S, Hassan C, Lorenzetti R, et al. Submucosal nodules containing purulent fluid: a colonoscopic sign of actinomycosis? Gastrointest Endosc 2004; 59:319.
- Kim JB, Han DS, Lee HL, et al. Diagnosis and partial treatment of actinomycosis by colonoscopic biopsy. Gastrointest Endosc 2004; 60:162.