La actinomicosis es una enfermedad crónica, supurativa y granulomatosa, producida por el Actinomyces Isarelii, germen saprofito de la orofaringe, tubo digestivo y aparato genital femenino. Aprovechando una puerta de entrada en la mucosa (apendicitis, diverticulitis, cuerpo extraño) se extiende por contigüidad formando fístulas, abscesos y fibrosis. La forma abdominal (22%) se inicia generalmente en la cecoapendicular (65%), con una clínica insidiosa atípica o en forma de masa abdominal sin filiar. Su diagnóstico, siempre difícil (< 10%), se realiza generalmente por laparotomía y anatomía patológica, y menos frecuentemente por PAAF y TC. El tratamiento es, además de la cirugía, penicilina G a dosis millonarias seguido de penicilina oral durante varios meses. Se consideran factores predisponentes demostrados: una mala higiene bucal y el uso del DIU. Presentamos tres casos de actinomicosis abdominal ocurridos en nuestro servicio en los últimos 10 años, recordando así la existencia de una enfermedad, que aunque rara, debe tenerse en cuenta en cuadros de masa abdominal sin filiar.
Actinomycosis is a chronic, suppurative, granulomatous disease caused by Actinomyces israelii, a saprophyte bacterium found in the oropharynx, digestive tube and female genitals. From a portal of entry in the mucosa (appendicitis, diverticulitis, foreign body), the infection spreads to contiguous tissue forming fistulas, abscesses and fibrosis. The abdominal form (22%), usually begins in the cecum and appendix (65%) with atypical slowly-progressive symptoms or in the form of an abdominal mass of unknown cause. Diagnosis is difficult (< 10%) and is usually performed by laparotomy and pathological examination and less frequently by fine-needle aspiration puncture and computed axial tomography. In addition to surgery, treatment consists of high doses of penicillin G followed by oral penicillin for several months. Demonstrated predisposing factors are poor oral hygiene and intrauterine devices. We present three cases of abdominal actinomycosis that occurred in our department in the last 10 years. Although rare, this disease should be taken into account in patients with symptoms of abdominal mass of unknown cause.
