Title Alternative A refractory cutaneous-rectovesical fistula complicated with abdominal actinomycosis successfully treated with antibiotic therapy
Author Katsura, Yuki| Matsukawa, Hiroyoshi| Kato, Takuya| Sugihara, Masahiro| Ojima, Yasutomo| Shiozaki, Shigehiro|
Abstract The patient was a 35-year-old Japanese man diagnosed with appendicitis with abscess formation. An appendectomy was performed, but a refractory surgical wound infection developed, and eventually a cutaneous-rectovesical fistula was detected. In a review of the first-time CT scan, a small high-density construction resembling a bone from a fish was detected in the ileum. The histopathological examination revealed granules of actinomyces. These findings suggested that abdominal actinomycosis due to intestinal mucosal breakage by the fish bone caused the secondary appendicitis, and that after the appendectomy, residual actinomyces caused the cutaneous-rectovesical fistula. After the diagnosis, total parenteral nutrition and a long-term administration of antibiotics improved the patient's clinical symptoms, and the fistula closed within a month. Antibiotics were administered for 6 months, and there has been no recurrence for 6-1/2 years. Because actinomycosis is difficult to diagnose based on the typical clinical features, a direct identification of the infecting organism from a tissue sample or from sulfur granules is required for the definitive diagnosis. Actinomyces is also known to cause fistula formation, and intestinal penetration caused by a fish bone may indicate abdominal actinomycosis. A rectovesical fistula requires surgical intervention in most cases, but in cases caused by abdominal actinomycosis, such a fistula may be cured by conservative therapy, as in our patient's case. It is important to consider the possibility of actinomycosis when a refractory rectovesical fistula is observed.
Keywords 放線菌症 (actinomycosis) 皮膚直腸膀胱瘻 (cutaneous-rectovesical fistula) 急性虫垂炎 (appendicitis)
Publication Title Journal of Okayama Medical Association
Published Date 2017-04-03
Volume volume129
Issue issue1
Start Page 35
End Page 39
ISSN 0030-1558
Official Url http://www.okayama-u.ac.jp/user/oma/|
language 日本語
Copyright Holders Copyright (c) 2017 岡山医学会
File Version publisher
DOI 10.4044/joma.129.35
Author Inada, Ryo| Nagasaka, Takeshi| Takehara, Kiyoto| Sugihara, Masahiro| Mori, Yoshiko| Umeda, Yuzo| Kubota, Nobuhito| Morikawa, Tatsuya| Kondo, Yoshitaka| Uno, Futoshi| Sadamori, Yu| Yagi, Takahito| Fujiwara, Toshiyoshi|
Published Date 2013-04-01
Publication Title 岡山医学会雑誌
Volume volume125
Issue issue1
Content Type Journal Article