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Omental actinomycosis mimicking a foreign body infection.

ABSTRACT: Actinomycosis is a chronic suppurative granulomatous disease caused by Actinomyces species. Abdominal actinomycosis is a rare condition and difficult to diagnose before surgery. Here, we report a case of omental actinomycosis mimicking a foreign body infection on computed tomography (CT). A 47-year-old man presenting with abdominal pain had a heterogeneous area comprising a 2-cm long linear radiopaque material with surrounding enhancing soft tissue density lesions and fat infiltrates, measuring 9 × 8 cm in the omentum of the right upper quadrant on CT. We assumed that the linear radiopaque material was a foreign body, such as a fish bone. Laparoscopy-assisted right hemicolectomy and partial omentectomy were performed under radiological suspicion of foreign body infection. Histological examination revealed the omental lesion to be actinomycosis. The patient was treated with antibiotics for 10 weeks, and he recovered well without any complication. Omental actinomycosis mimicking a foreign body infection is rare. The experience and knowledge regarding the variable CT findings of abdominal actinomycosis are useful because it should be differentiated from malignancy and other inflammatory conditions.

SUBMITTER: Jeong MJ

PROVIDER: S-EPMC9270208 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:The clinical manifestations of foreign body (FB) aspiration can range from an asymptomatic presentation to a life-threatening emergency. Patients may present with acute onset cough, chest pain, breathlessness or sub-acutely with unexplained hemoptysis, non-resolving pneumonia and at times, as an incidental finding on imaging. Patients with iatrogenic FB such as an aspirated broken tooth during difficult intubation or a broken instrument are more common scenarios in the intensive care unit (ICU). Patients with post-obstructive pneumonia with or without sepsis, or variable degree of hemoptysis often require ICU level of care and bronchoscopic interventions. Rigid bronchoscopy has traditionally been the modality of choice; however, with the innovation in instrumentation and wider availability of flexible bronchoscopes, most of the FB removal is now successfully performed using flexible bronchoscopy. Proceduralists choose instruments in accordance with their training and expertise. We describe the use of most common instruments including forceps, balloon catheters, and baskets. Role of cryoprobe and LASER in FB removal is reviewed as well. In general, larger working channel bronchoscopes are preferred; however, smaller working channel bronchoscopes may be used in situations when the patients are intubated with a smaller diameter endotracheal or tracheostomy tubes. Large size FB are removed en bloc with the grasping tool, bronchoscope, and endotracheal or tracheostomy tube, requiring preparation to safely re-establish the airway. After FB removal, bronchoscopy is re-performed to identify any residual FB, assess any injury to the airway, suction post-obstructive secretions or pus, control any active bleeding and remove granulation tissue that may be obstructing the airway. Additional interventions like balloon dilatation may be required to dislodge an impacted FB or to maintain patency of bronchial lumen. If bronchoscopic methods fail, surgery may be required for retrieval of FB in symptomatic patients or to resect suppurative or necrotizing lung process. Multidisciplinary approach involving intensivists, surgeons, and anesthesiologists is the key to optimal patient outcomes.

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Omental actinomycosis mimicking a foreign body infection.

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