Primary Abdominal Wall Actinomycosis: Report of a Case

原發性前腹壁放射線菌感染：一病例報告

彭文秀(Vun-Sien Pang) ； 劉裕財(Yu-Tsai Liu) ； 葉永祥(Yung-Hsiang Yeh) ； 楊基滐(Chich-Chieh Yang) ； 陳建華(Chien-Hua Chen) ； 方怡仁(Yi-Jen Fang) ； 吳志昇(Chih-Shen Wu) ； 朱彥璋(Yen-Chang Chu) ； 蘇信榮(Sing-Jung Su)

《臺灣消化醫學雜誌》 23卷2期 (2006/06) Pp. 158-165

https://doi.org/10.6557/GJT.200606_23(2).0007

摘要

原發性放射線菌感染侵犯到前腹壁在英文文獻是少見的，術前診斷更困難。放射線菌感染主要是一種慢性細菌性感染，通常是由Actinomyces isrealii引致居多。我們報告一位57歲男性病例，之前從無開刀史，但為一名第二型糖尿病患者並有定期服用降血糖控制藥物。在病發之前四個月，該患者曾經歷過一次的機車車禍，並引致左前腹部挫傷但無明顯之外傷，之後該患者發現在肚臍左上方有一個快速成長之腫瘤狀病灶，而來院就醫。腹部超音波及腹部斷層掃描顯示左側前腹直肌有一腫瘤狀病灶並侵犯到鄰近之腹膜及腸繫膜。由於病灶只位於前腹直肌下方，因此我們利用超音波指引的方式作生檢。病理報告顯示為放射線菌之感染而無其他惡性細胞發現，因此我們給予抗生素(Augmentin)之使用，並合併治療患者之糖尿病。由於患者之順從性欠佳只服用一星期之抗生素並拒絕手術治療，所以我們只好採用內科療法，而一般應服用至少六星期至三個月之抗生素。之後患者在一般診所接受多次重複細針抽膿治療四個月，病灶逐浙消失。

關鍵字

前腹壁放射線菌感染 ； 放射線菌 ； 超音波指引生檢 ； 硫磺顆粒

並列摘要

Actinomycosis primarily involving the anterior abdominal wall is rare and difficulties always arise in differential diagnosis preoperatively. It is an infection primarily caused by the bacteria Actinomyces isrealii. We report the case of a 57-year-old male patient, previously healthy except for type Ⅱ diabetes mellitus controlled with regular oral hypoglycemic agents (OHAs). Past surgical history was denied. He was involved in a motorcycle traffic accident 4 months prior to his presentation, and a fast growing mass was noted in the left upper umbilical area. Abdominal ultrasonography revealed a heterogeneous mass (7.4×4.7cm) over the left-upper umbilical region with minimal ascites. Enhanced abdominal computed tomography (CT) revealed an ill-defined enhanced mass involving the omentum and mesentery associated with enlargement of the left rectus abdominis muscle, and thickening of the adjacent large bowel wall. Echo-guided biopsy was done from the tumorous lesion just located beneath the left anterior abdominal wall. Histopathology revealed acute and chronic inflammation with actinomyces colonies but no malignant cells. The patient refused surgical intervention and only accepted antibiotic for 7 days. He then was treated by repeated aspiration at local clinics. The lesion gradually subsided after 4 months of such treatments.

並列關鍵字

abdominal wall actinomycosis ； actinomyces ； echo-guided biopsy ； sulfur granules.