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Query: UMLS:C0000737 (abdominal pain)
 31,184 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A palpable tumour was discovered in the left lower abdomen of a 66-year-old woman with uncharacteristic lower-abdominal pain and treatment-resistant pollakisuria and stress incontinence. On ultrasound examination the tumour was about 6.0 x 2.5 x 2.5 cm in size and was located between bladder roof and anterior abdominal wall. Ultrasound-guided fine-needle biopsy failed to produce any cytologically interpretable material, and there was no bacterial growth from the aspirate. All clinical and biochemical findings were normal, except for a raised blood-sedimentation rate (15/43 mm). The tumour, completely removed at laparotomy, was diagnosed to be actinomycosis of the bladder. No long-term postoperative antibiotic treatment was undertaken. Nine months after the operation the patient was without symptoms and there were no abnormal clinical findings.
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PMID:[Actinomycosis of the bladder]. 267 48

2 cases of pelvic Actinomycosis both in women 40 years of age, with IUDs in place for 8 and 10 years respectively, were diagnosed with the aid of radiologic techniques including barium enema, computed tomography (CT) and magnetic resonance imaging (MR). The 1st woman had experienced malaise, night sweats and a weight loss of 15 lb. over 2-3 months, then felt an epigastric mass for 5 days. She has endometritis, elevated white blood cell count, and large, tender, bilateral adnexal masses. Inflammatory changes and multilocular fluid collections were demonstrated by enhanced CT. Aspiration of the epigastric mass yielded sulfur granules and anaerobic bacteria. She was successfully treated with penicillin, gentamycin and clindamycin. The 2nd woman had a 2-month history of abdominal pain, a pelvic mass and an elevated white blood cell count. Enhanced CT, barium enema and sigmoidoscopy demonstrated a mass between the uterus and bowel, with mural invasion of the sigmoid colon. A 5 x 6 cm left-sided tubo-ovarian abscess adhering to the colon, bladder and left pelvic sidewall was excised at laparotomy. She remained asymptomatic at 6 months. This lethal but curable condition is caused by Actinomyces israelii, an opportunistic gram-positive bacteria usually introduced by foreign bodies, surgery or trauma. CT and MR were helpful in diagnosing the relatively nonspecific signs and symptoms in these cases.
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PMID:Pelvic actinomycosis associated with intrauterine devices. 291 83

This paper presents the 1st reported case of actinomycosis of the subcutaneous tissues and abdominal wall without pelvic organ involvement in an IUD user. The patient, a 39-year old woman, para 4-0-1-4, presented with lower abdominal pain. Pap smear findings were reported as cervical intraepithelial neoplasia, grade I-II, and endocervical curettage showed colonies of Actinomyces species. A subsequent cone biopsy revealed carcinoma in situ but no evidence of Actinomyces. The final diagnosis was cervical intraepithelial neoplasia, leiomyomata, and actinomycotic abscesses of the abdominal wall. It is suggested that systemic actinomycosis be included in the differential diagnosis of pain in IUD users when Actinomyces is found on Pap smears or in endocervical curettings. Treatment of actinomycosis generally involves intravenous aqueous penicillin, 10-20 million units/day for 4-5 days, followed by 2-15 million units/day of oral penicillin for 3 weeks-1 year. Longterm antibiotic therapy is particularly important prior to any surgical intervention. If left untreated, actinomycosis can lead to infection, brain abscess, or death.
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PMID:Abdominal wall actinomycosis associated with an IUD. A case report. 315 87

The case-study of genital actinomycosis in a 33-year old woman wearing a "Copper T200" IUD is presented. She was hospitalized and treated for lower abdominal pain and non-characteristic signs of adnexitis twice. Adnexectomy on the left side was performed to remove an orange-size cyst. Histo-pathological examination of a prepared tissue sample revealed a colony of Actinomyces. Following the operation the patient was treated with 3 x 500 mg Flagyl (metronidazole) 3 x 80 mg of Gentamicin im. The wound healed in 19 days after operation. This woman had worn the IUD continuously for more than 3 years, thus there was an increased risk of uterine lesions. The most frequent consequences of wearing IUDs for a long time are dysmenorrhea and endometritis and therapeutic approaches are detailed. Since its first description in the literature in 1857 actinomycosis has not been mentioned frequently. However, with the spread of IUDs, the number of actinomycosis-like cases has increased and this justifies the need for improved diagnosis. The frequency of actinomycosis occurring in women wearing IUDs ranges between 1.6% and 19.7%
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PMID:[Adnexal actinomycosis in a woman using an intrauterine contraceptive device (IUD)]. 358 37

A 43-year-old man, with a chief complaint of abdominal pain and a palpable mass in the lower abdomen, was admitted to this hospital. He had 2-3 episodes of diarrhea monthly for several years. Laparotomy revealed the mass resembling sarcoma, invaded the ileum and bladder and also it had disseminated lesions in the other intraabdominal organs. Resected tissues showed actinomycotic abscess. AB-PC was administered post-operatively, with a satisfactory prognosis. On the 71 patients with abdominal actinomycosis who underwent laparotomy during the past 32 years in Japan, 42 were males and 28 females. Many of them were in their forties or fifties. Some literatures mention the ileocecal region as the usual site of following perforated appendicitis. As far as this review is concerned, however, the transverse colon was as frequently affected as the ileocecal region and it was only in 13 patients that acute appendicitis preceded the infection. Abdominal actinomycosis is not an uncommon disease and should be taken into consideration in the differential diagnosis of the abdominal mass.
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PMID:[A case of abdominal actinomycosis]. 360 May 98

This case report presents an unusual case of primary IUD-associated ovarian actinomycosis, which spread to the sigmoid causing intestinal obstruction. A 43-year-old gravida 3, para 2, had her 1st IUD from 1978-80 (Gyne-T) and her 2nd IUD from 1980 to October 1983 (Multiload). Right lower abdominal pain led to hospitalization in May 1983. A tender nodular mass was palpated in the left pelvic area. Laboratory results confirmed the presence of inflammation. Rapid improvement followed a course of laxatives and cephalosporin antibiotics, and the patient was discharged with the diagnosis of acute sigmoid diverticulitis. 2 months later, a double contrast examination of the large intestine was done and showed severe narrowing of the sigmoid colon over a distance of 12 cm and occasional sharp recesses. Colonoscopy showed a spastic stricture of the sigmoid with massive edema of the otherwise intact mucosa at 18 cm. Computer tomography of the abdomen showed a large, focally cystic infiltrative mass in the pelvis with congestion and displacement of both ureters as well as bilateral hydronephrosis, predominantly on the right side. The descending colon was congested. The patient was readmitted to hospital with the tentative diagnosis of ovarian cancer when her general condition deteriorated. She complained again of abdominal pain in the right lower quadrant and alternating diarrhea and constipation. Pyrexia and the hematological findings suggested sepsis. The pelvis contained a predominantly leftsided nodular mass and a brown fetid discharge was coming through the cervix. The IUD was removed and treatment with ampicillin and clindamycin was started with rapid improvement in the patient's condition. Obstruction with extreme distention of the colon required emergency laparotomy. An inflammatory mass was found in the pelvis consisting of a right-sided ovarian tumor, bilateral hydrosalpinges, and a tightly encased sigmoid colon. The dilated caecum had a large necrotic area in its wall which necessitated caecostomy and double-current sigmoidostomy after subtotal hysterectomy and bilateral salpingo-oophorectomy. The patient made a good recovery. As recently as the 1950s, primary pelvic actinomycosis was a rarity. In the last 4 years alone, 20% of all reported cases of actinomycosis involved the female genital tract. The percentage of cases found among IUD users has been continuously increasing and in the last 2 years all published cases were IUD users. The presence of actinomyces in vaginal smears always is indicative of the presence of a foreign body, most commonly and IUD.
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PMID:IUD-associated ovarian actinomycosis causing bowel obstruction. 374 Sep 65

The incidence of pelvic inflammatory disease (PID) attributable to IUD use has been increasing, especially after the removal of the Dalkon shield from the market, but this relationship has not been settled conclusively. In recent decades PID included a variety of infections, but lately the definition of PID has meant acute ascending infections of the female genital tract. Its most common risk factors include promiscuity of IUD use, although this can be reduced to one fourth by regular checkups and proper hygiene. The frequency of PID is estimated at 2-5% of IUD users. Microorganisms contributing to PID include Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma hominis, Escherichia coli, Proteus, Staphylococcus epidermis, Haemophilus influenzae, Bacteroides, Peptococcus, Peptostreptococcus, Clostridium, and Actinomyces israelii, The differentiation of actinomycosis (AC) and pseudoactinomycosis (PAC) is well advised. The potential of IUD use in increasing the risk of AIDS should not be discounted. The clinical picture of PID is varied, it can be mild requiring conservative drug therapy; with medium severity requiring removal of the IUD and drug therapy; severe necessitating removal, antibiotics and sulfonamide treatment and laparotomy; and very severe with potentially fatal generalized sepsis. In addition to antibiotics, e.g., penicillin, treatment can include the so called catastrophy combination of Mandokef- Metronidazol-Gentamycin. An analysis of the data of 8536 IUD fittings in Debrecen, Hungary showed 1.4% removals due to PID after 4 years, 694 patients (8.1%) had lower abdominal pain 73 of which (0.9%) had palpable resistance, and suppuration occurred in only 30 cases (0.4%). Treatment included Semicillin or Tetran, or removal of the IUD, and even surgery if no improvement resulted. Prevention of PID include elimination of risk factors, the careful selection of IUD users, regular checkups, the use of copper (Cu) T device, and strict adherence to professional standards.
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PMID:[The role of intrauterine contraceptive devices in the development of inflammatory processes in the small pelvis]. 376 5

This paper presents the 1st reported case of Actinomyces naeslundii isolation in pelvic actinomycosis in an IUD user. Up until this point, all such cases of infection had been linked to A. israelii. The patient was a 39-year old woman who had had a Dalkon Shield device inserted 10 years prior to her admission with sharp, progressive abdominal pain. Scanning revealed a midline, posterior, extrauterine, large, complex mass which was reduced dramatically in size after treatment with penicillin and probenecid. Direct immunofluorescence clearly identified the organism recovered from the IUD as A. naeslundii, although the clinocopathologic presentation in this case was similar to that found in A. israelii-related pelvic actinomycosis. Most infections with this agent are restricted to the oral cavity. However, these findings suggest that A. naeslundii is an occasional saprophyte of the lower genital tract as well. Orogenital sexual practices are believed to provide actinomycetes with access to the genital tract. The patient in this case had 2 risk factors for developing pelvic actinomycosis: use of the Dalkon Shield (the model associated with the highest incidence of infection) and longterm IUD use.
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PMID:Actinomyces naeslundii as an agent of pelvic actinomycosis in the presence of an intrauterine device. 397

In the past Actinomycosis has been associated with diverticular disease of the colon, abdominal surgery, cholecystitis, and penetrating trauma. Recent reports have demonstrated an increased incidence in women using IUDs. Such a case is presented. a 40-year-old woman experienced lower abdominal pain and a 20 pound weight loss over a 2 month period. The patient had had an IUD (a Dalkon shield) placed 7 years previously and had not sought medical attention since then. Pelvic examination revealed an IUD in place and an 8 cm mass fixed to the left side wall and displacing the rectum. The IUD was removed after the pelvic examination. Laboratory studies were all within normal limits except for mild anemia. A computed tomographic scan of the pelvis showed a left hydroureter, an 8 cm pelvic mass with left side wall extension, and displacement of the rectum to the right. A barium enema examination showed fixed narrowing of the rectum and mucosal irregularity. A fine needle aspiration biopsy showed endometritis and frank pus with the presence of Actinomyces. Surgery confirmed these findings. The patient responded to antibiotic therapy after surgery and did well. The colonization of the vagina, cervix, and uterus by Actinomyces and complications such as tubo-ovarian and pelvic abscesses have been reported in IUD users. 1 study reported Actinomyces in as many as 25% of IUD users, although all patients in that study were asymptomatic. In addition, this group had an increased incidence of abnormal pap smears, which may add a confusing note in the event of a pelvic mass. The association if IUD use and abscess appears increased in those patients who have had the same iud in place for more that 2 years, although the complication has been reported only 2 1/2 months following IUD insertion. Actinomycosis is a diagnosis seldom made before biopsy or surgery. Culture of the organism is essential and the diagnosis is best made using immunofluorescent staining of formaldehyde-fixed, paraffin-embedded tissue. This needle biopsy can provide a quick diagnosis. Therapy includes high dose penicillin, to which the disease responds quickly, and incision and drainage if necessary. Prompt diagnosis and adequate treatment reduce the morbidity of dissemination and of chronic infection.
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PMID:Pelvic actinomycosis. 686 30

Pelvic actinomycosis of the female genital tract is an indolent suppurative inflammation involving the adnexal tissues and occasionally, the endometrium. It is becoming increasingly associated with IUD use, and its diagnosis is seldom made preoperatively. This report presents a case of widespread, unrecognized pelvic actinomycosis involving the rectum in an IUD-wearer. It also illustrates the difficulty in diagnosing and managing this disorder. A 43-year old woman admitted to the University Hospitals presented with a severe process which mimicked a pelvic malignancy. 8 months prior to admission, she had an IUD in place for 11 years removed due to irregular menstrual bleeding; dilatation and curettage revealed tissues associated with acute endometritis and several Actinomyces colonies were observed in a cervical smear. At the University Hospitals, diagnosis of pelvic actinomycosis was not suspected preoperatively. Exploratory laparotomy, hysterectomy, and bilateral salpingo-oophorectomy revealed no gross evidence of malignancy. Modified abdominoperitoneal resection was performed, leaving a sigmoid colostomy in place. Multiple histologic sections necessitated the confirmation of the diagnosis of actinomycosis. Presence of bilateral salpingo-oophoritis and the fact that Actinomyces colonies were observed in cervical smear strongly indicate that the initial focus of infection was related to the IUD rather than an intestinal site. The patient recovered uneventfully and was well at a 3-month follow-up. This case demonstrates also the progression of suppurative disease despite prior removal of IUD. Pelvic actinomycosis should be considered in patients with IUD, or those who have had them removed recently and those who are experiencing abdominal pain, recurrent vaginal bleeding, and adnexal masses.
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PMID:Intrauterine device-associated actinomycosis simulating pelvic malignancy. 723 38


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