Surgical aspects of the treatment of a patient with actinomycosis of the colon complicated by the formation of a colovesical fistula

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Abstract

Actinomycosis is a chronic bacterial infection caused by bacteria from the Actinomycetaceae family. The causes of abdominal actinomycosis are usually destructive appendicitis, prolonged presence of an intrauterine contraceptive or perforation of the colon. Of the internal organs, the left colon and sigmoid colon are most often affected, which often leads to surgical complications. At the same time, diagnosis is significantly difficult due to the nonspecific nature of the clinical presentation, which is similar to that of oncological diseases, and verification of the process is possible only with microscopic examination in a specialized institution.

A clinical case demonstrating the difficulties of diagnosis and treatment of widespread abdominal actinomycosis complicated by the development of a colovesical fistula is presented.

About the authors

Badri V. Sigua

North-Western State Medical University named after I.I. Mechnikov

Email: dr.sigua@gmail.com
ORCID iD: 0000-0002-4556-4913
SPIN-code: 5571-8893

MD, Dr. Sci. (Med.), Professor

Russian Federation, 41 Kirochnaya St., Saint Petersburg, 191015

Alexey A. Kurkov

North-Western State Medical University named after I.I. Mechnikov

Email: dok.kurkov@gmail.com
ORCID iD: 0000-0002-2128-8651
SPIN-code: 6396-4386

MD, Cand. Sci. (Med.)

Russian Federation, Saint Petersburg

Elguja L. Lataria

North-Western State Medical University named after I.I. Mechnikov

Email: Elguja.Lataria@szgmu.ru
ORCID iD: 0000-0002-9569-8485
SPIN-code: 7376-9672

MD, Cand. Sci. (Med.), Assistant Professor

Russian Federation, 41 Kirochnaya St., Saint Petersburg, 191015

Olga P. Kozlova

North-Western State Medical University named after I.I. Mechnikov

Email: olgakozlova07@gmail.com
ORCID iD: 0000-0002-2467-4945
SPIN-code: 6312-0770

MD, Cand. Sci. (Med.), Assistant

Russian Federation, 41 Kirochnaya St., Saint Petersburg, 191015

Dmitrii V. Gurzhiy

North-Western State Medical University named after I.I. Mechnikov

Email: gurzhiydv@ro.ru
ORCID iD: 0000-0002-4005-0403
SPIN-code: 7344-3941
Scopus Author ID: 365404

MD, Cand. Sci. (Med.), Assistant Professor

Russian Federation, Saint Petersburg

Sergey A. Vinnichuk

North-Western State Medical University named after I.I. Mechnikov

Email: Sergei.Vinnichuk@szgmu.ru
ORCID iD: 0000-0002-9590-6678
SPIN-code: 6448-9110

MD, Cand. Sci. (Med.), Assistant Professor

Russian Federation, 41 Kirochnaya St., Saint Petersburg, 191015

Alexey L. Efimov

North-Western State Medical University named after I.I. Mechnikov

Email: aespb@mail.ru
ORCID iD: 0000-0001-7586-6405
SPIN-code: 7854-1596

MD, Cand. Sci. (Med.), Assistant Professor

Russian Federation, 41 Kirochnaya St., Saint Petersburg, 191015

Gleb V. Chizhov

North-Western State Medical University named after I.I. Mechnikov

Email: gleb.chizhov.98@mail.ru

MD

Russian Federation, 41 Kirochnaya St., Saint Petersburg, 191015

Andrey A. Khvatov

North-Western State Medical University named after I.I. Mechnikov

Email: andrey_hvatov@mail.ru
ORCID iD: 0009-0005-8859-5030

MD

Russian Federation, 41 Kirochnaya St., Saint Petersburg, 191015

Viacheslav P. Zemlianoi

North-Western State Medical University named after I.I. Mechnikov

Author for correspondence.
Email: zeml.spb@mail.ru
ORCID iD: 0000-0003-2329-0023

MD, Dr. Sci. (Med.), Professor, Honored Doctor of the Russian Federation

Russian Federation, 41 Kirochnaya St., Saint Petersburg, 191015

References

  1. Toidze VV, Akimov VP, Churgulia MZ, et al. Difficulties in the diagnosis of abdominal actinomycosis. The Hospital. 2019;(2(28)):18–21. (In Russ.)
  2. Kozlova OP, Shevyakov MA, Klimko NN. Abdominal’nyi aktinomikoz. Klinika, diagnostika, lechenie. Uspekhi meditsinskoi mikologii. 2017;17:256–257. (In Russ.)
  3. Mirzabalaeva AK, Kozlova OP, Chernopyatova AK, et al. Case of successful treatment of widespread abdominal actinomycosis. Journal Infectology. 2009;1(2–3):81–86. (In Russ.) doi: 10.22625/2072-6732-2009-1-2,3-81-86
  4. Petrie BA, Schwartz SI, Saltmarsh GF. Intra-abdominal actinomycosis in association with sigmoid diverticulitis. Am Surg. 2014;80(6):157–159. doi: 10.1177/000313481408000603
  5. Das K, Karateke F, Ozyazıcı S. Unusual presentations of actinomycosis; anterior abdominal wall and appendix: report of three cases. Balkan Med J. 2013;30(3):315–317. doi: 10.5152/balkanmedj.2012.377
  6. Chzhao AV, Andrejceva OI, Zhavoronkova OI, et al. Abdominal actinomycosis (clinical case). Vysokotekhnologicheskaya medicina. 2018;5(3):11–22. (In Russ.)
  7. Tortorano AM, Richardson M, Roilides E, et al. ESCMID and ECMM joint guidelines on diagnosis and management of hyalohyphomycosis: Fusarium spp., Scedosporium spp. and others. Clin Microbiol Infect. 2014;20 Suppl 3:27–46. doi: 10.1111/1469-0691.12465
  8. Melchior S, Cudovic D, Jones J, et al. Diagnosis and surgical management of colovesical fistulas due to sigmoid diverticulitis. J Urol. 2009;182(3):978–982. doi: 10.1016/j.juro.2009.05.022

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2. Fig. 1. A microscopic image of a biopsy of the pelvic tumor (hematoxylin-eosin, magnification ×100)

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3. Fig. 2. Computed tomography of the abdomen. The arrow indicates free gas in the bladder cavity

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4. Fig. 3. Computed tomography of the abdominal organs. The arrows indicate the ureters; ureterectasia is visualized on the left

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5. Fig. 4. Computed tomography of the abdomen. The arrow indicates pyelectasis on the left

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6. Fig. 5. Computed tomography of the abdomen. Infiltrate in the pelvic cavity is indicated

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