Computed tomography for the preoperative diagnosis of pelvic actinomycosis

Aims: The aim of this study was to review the clinical manifestations of pelvic actinomycosis in order to aid clinicians in its diagnosis and treatment. Methods: We retrospectively reviewed the histopathology and clinical records of all cases confirmed by surgery as pelvic actinomycosis from 1996 to 2006. Results: A total of 16 cases of pelvic actinomycosis were selected and evaluated. The median age was 51 years (range, 36-66 years). All patients experienced childbirth, and had risk factors including use of an intrauterine device (93.8%) or pessary (6.2%), and/or a history of dilatation and curettage (68.8%), or previous abdominal surgery (31.3%). Nine patients (56.3%) were correctly diagnosed before surgery with computed tomography. Other common preoperative diagnoses were intra-abdominal malignancy (18.8%) and tubo-ovarian abscess (25%). The most common initial laboratory abnormalities were anemia (68.8%) and leukocytosis (62.5%). In six patients (37.5%), the preoperative values of carbohydrate antigen-125 were elevated. All patients were cured by surgery and no recurrence or mortality was noted. Conclusions: The correct initial diagnosis of pelvic actinomycosis is important for decreasing treatment-related morbidity. Imaging studies, especially computed tomography, might have assisted the diagnoses of actinomycosis.