Enterovesical Fistula Associated with Pelvic Actinomycosis: Case Report and Literature Review
Actinomycosis is a rare chronic, suppurative infection caused by the bacteria of the Actinomyces species. This chronic infection may present with a variety of symptoms. Florid abscess formation with fistulation, abundant granulation and dense surrounding fibrosis are common. Diagnosis prior to, or even during surgery is rare and the findings are usually mistaken for inflammatory process or malignancy. Abdominal actinomycosis has been recognized for over 150 years yet is largely unknown to most clinicians. It was once described as “the most misdiagnosed disease”.
We report here a 59-year-old woman who presented with enterovesical fistula secondary to pelvic actinomycosis. Its recognition is important as clinical and radiological findings may mimic malignancy and lead to radical and unnecessary surgery. A high index of suspicion for this rare but devastating condition must be maintained. To our knowledge, this is the second reported case of enterovesical fistula secondary to pelvic
actinomycosis in the English language literature. The literature on abdomino-pelvic actinomycosis was reviewed.
principles of management. J Am Coll Surg 2009;209:484-91.
2. Pickhardt PJ, Bhalla S, Balfe DM. Acquired gastrointestinal
fistulas: classification, etiologies, and imaging evaluation.
3. Ferguson GG, Lee EW, Hunt SR, et al. Management of the
bladder during surgical treatment of enterovesical fistulas
from benign bowel disease. J Am Coll Surg 2008;207:569-72.
4. Cripps H. Passage of gas and feces through the urethra:
colectomy, recovery, remarks. Lancet 1888;2:619-20.
5. Choi MM, Beak JH, Lee JN, et al. Clinical features of
abdominopelvic actinomycosis:report of twenty cases and
literature review. Yonsei Med J 2009;50:555-9.
6. Kaszuba M, Tomaszewska R, Pityñski K, et al. Actinomycosis
mimicking advanced cancer. Pol Arch Med Wewn 2008;
7. Choi MH, Hong DG, Seong WJ, et al. Pelvic actinomycosis
confirmed after surgery:single center experience. Arch
Gynecol Obstet 2009 Jun 30. [Epub ahead of print]
8. Fernández-Aceñero MJ, Silvestre V, Fernández-Roldán R, et
al. Gastric actinomycosis:a rare complication after gastric
bypass for morbid obesity. Obes Surg 2004;14:1012-5.
9. Kayikcioglu F, Akif Akgul M, Haberal A, et al. Actinomyces
infection in female genital tract. Eur J Obstet Gynecol
Reprod Biol 2005;118:77-80.
10. Devendra K, Chen CM. Pelvic actinomycosis masquerading
as an acute abdomen from a small bowel perforation.
Singapore Med J 2008;49:158-9.
11. Isik B, Aydin E, Sogutlu G, et al. Abdominal actinomycosis
simulating malignancy of the right colon. Dig Dis Sci
12. Ferrari TC, Couto CA, Murta-Oliveira C, et al. Actinomycosis
of the colon: a rare form of presentation. Scand J
13. Wang YH, Tsai HC, Lee SS, et al. Clinical manifestations of
actinomycosis in Southern Taiwan. J Microbiol Immunol
14. Marella VK, Hakimian O, Wise GJ, et al. Pelvic actinomycosis.
Urologic perspective. Int Braz J Urol 2004;30:367-76.
15. Taga S. Diagnosis and therapy of pelvic actinomycosis. J
Obstet Gynaecol Res 2007;33:882-5.
16. Wagenlehner FM, Mohren B, Naber KG, et al. Abdominal
actinomycosis. Clin Microbiol Infect 2003;9:881-5.
17. Stringer MD, Cameron AE. Abdominal actinomycosis:a
forgotten disease? Br J Hosp Med 1987;38:125-7.
18. Atay Y, Altintas A, Tuncer I, et al. Ovarian actinomycosis
mimicking malignancy. Eur J Gynaecol Oncol 2005;26:663-
19. Sehouli J, Stupin JH, Schlieper U et al. Actinomycotic
inflammatory disease and misdiagnosis of ovarian cancer.
A case report. Anticancer Res 2006;26:1727-31.
20. Hepperlen TW, Stinson W, Hutson J, et al. Epithelialization
after cystotomy. Invest Urol 1975;12:269-71.
21. Kavanagh D, Neary P, Dodd JD, et al. Diagnosis and
treatment of enterovesical fistulae. Colorectal Dis 2005;7:286-
22. Daniels IR, Bekdash B, Scott HJ, et al. Diagnostic lessons
learnt from a series of enterovesical fistulae. Colorectal Dis
23. Larsen A, Johansen TEB, Solheim BM, et al. Diagnosis and
treatment of enterovesical fistula. Eur Urol 1996;29:318-21.
24. Ravichandran S, Ahmed HU, Matanhelia SS, et al. Is there a
role for magnetic resonance imaging in diagnosing
colovesical fistulas? Urology 2008;72:832-7.
25. McBeath RB, Schiff M Jr, Allen V, et al. 12-Year experience
with enterovesical fistulas. Urology 1994;44:661-5.
26. Munoz M, Nelson H, Harrington J, et al. Management of
acquired rectourinary fistulas. Dis Colon Rectum 1998;41:
27. Law WL, Chu SM. An unusual enterovesical fistula. Am J Surg
28. Kirsh GM, Hampel N, Shuck JM, et al. Diagnosis and
management of vesicoenteric fistulas. Surg Gynecol Obstet
29. Liu CH, Chuang CK, Chu SH, et al. Enterovesical fistula:
experiences with 41 cases in 12 years. Changgeng Yi Xue Za
30. Moss RL, Ryan JA. Management of enterovesical fistulas.
Am J Surg 1990;159:514-8.
31. Amin M, Nallingerr R, Polk HC. Conservative treatment of
selected patients due to diverticulitis. Surg Gynecol Obstet
32. Hall V. Actinomyces-Gathering evidence of human
colonization and infection. Anaerobe 2008;14:1-7.
33. Huang CJ, Huang TJ, Hsieh JS. Pseudo-colonic carcinoma
caused by abdominal actinomycosis:report of two cases.
Int J Colorectal Dis 2004;19:283-6.
34. Alam MK, Khayat FA, Al-Kayali A, et al. Abdominal
actinomycosis:case reports. Saudi J Gastroenterol 2001;7:37-
35. Garner JP, Macdonald M, Kumar PK. Abdominal
actinomycosis. Int J Surg 2007;5:441-8.
36. Lee YM, Law WL, Chu KW. Abdominal actinomycosis. ANZ
J Surg 2001;71:261-3.
37. Sumer Y, Yilmaz B, Emre B, et al. Abdominal mass secondary
to actinomyces infection: an unusual presentation and its
treatment. J Postgrad Med 2004;50:115-7.
38. Lee SH, Kim HJ, Kim HJ et al. Primary gastric actinomycosis
diagnosed by endoscopic biopsy:case report. Gastrointest
39. Henderson SR. Pelvic actinomycosis associated with an
intrauterine device. Obstet Gynecol 1973;41:726-32.
40. Fiorino AS. Intrauterine contraceptive device-associated
actinomycotic abscess and actinomyces detection on
cervical smear. Obstet Gynecol 1996;87:142-9.
41. Yeguez JF, Martinez SA, Sands LR, et al. Pelvic actinomycosis
presenting as malignant large bowel obstruction:a case
report and a review of the literature. Am Surg 2000;66:85-90.
42. Atad J, Hallak M, Sharon A, et al. Pelvic actinomycosis. Is
long-term antibiotic therapy necessary? J Reprod Med
43. Piper JV, Stoner BA, Mitra SK, et al. Ileo-vesical fistula
associated with pelvic actinomycosis. Br J Clin Pract 1969;23:
How to Cite
Articles must be contributed solely to The Thai Journal of Surgery and when published become the property of the Royal College of Surgeons of Thailand. The Royal College of Surgeons of Thailand reserves copyright on all published materials and such materials may not be reproduced in any form without the written permission.