Pneumoperitoneum in Sigmoid Colon Actinomycosis
摘要
Actinomyces are Gram-positive. They are not fungi, anaerobic, and filamentous like the normal bacterial inhabitants of the oral cavity and upper intestinal tract of humans. Radiological studies have not been very useful in their preoperative diagnosis. Actinomycosis can only be diagnosed with certainty upon the finding of typical sulfur granules during histopathologic examination. In the presence of risk factors, it should be included in the differential diagnosis when the abdominal computed tomography^6 shows bowel thickening or a peritoneal mass with extensive infiltration. Surgical resection followed by high dosages of penicillin for two to six weeks, depending on the clinical symptoms, is still the main modality of treatment, especially when there is associated perforated viscus. There commendations are a penicillin-G dosage of 10 to 20 million units per day for four to six weeks, then oral penicillin at 20 to 30 mg per kg every six hours for an additional 6 to 12 months. Herein, we report a case of colonic actinomycosis presenting with pneumoperitoneum confirmed post-operatively by evidence of the histopathologic presence of sulfur granules.