Bilateral Hydronephrosis and Hydroureters as First Manifestation of Abdominal Actinomycosis: A Case Report

阻塞性尿路病變在急診室是經常碰到的情況。它可能經由多種腹腔內病變所引起，像是感染、發炎、結石、或是腫瘤。我們報告一例經由骨盆腔病理切片證實以阻塞性尿路病變為初步表徵之腹部放線菌病之四十一歲女性，這可能和子宮內避孕器的使用有關。腹部電腦斷層掃描顯示一個不尋常的影像，包括一浸潤性的不規則後腹腔腫塊圍燒鄰近的輸尿管而導致雙側腎盂績水和輸尿管績水。腹部放線菌病是不常見的感染性疾病，然而腹部內有浸潤性的異常時，特別在有子宮內避孕器的病人，必需列入鑑別診斷。因此，所有急診醫師對於急診有子宮內避孕器的病人應警覺。確定診斷則要病理切片組織中顯示放射菌的含硫顆粒，培養出放射菌或是兩者皆有。

關鍵字

放線菌病；避孕器；腎盂績水；輸尿管績水

並列摘要

Obstructive uropathy is a commonly encountered medical condition in an emergency room. Many intraabdominal lesions, such as infections, inflammations, stones or tumors, may cause it. We report a case of abdominal actinomycosis in a 41-year-old female who had been pathologically proved pelvic actinomycosis, which may be related to the use of an intrauterine contraceptive device (IUCD) with initial manifestation of obstructive uropathy. Her abdominal computed tomography (CT) scan revealed an unusual clinical feature consisting of an infiltrative and irregular retroperitoneal soft-tissue mass encasing the adjacent ureters resulting in bilateral hydronephrosis and hydroureters. Abdominal actinomycosis is an uncommon infectious disease that must be included among the differential diagnoses of infiltrative intra-abdominal disorders, especially in the patient with an IUCD. Therefore, all emergency physicians should be alert to any patient with an IUCD in situ in the emergency department (ED). Definite diagnosis is generally based on the histopathologic identification of the actinomycotic sulfur granules, culture of the Actinomyces or both.

並列關鍵字

actinomycosis ； contraceptive device ； hydronephrosis ； hydroureters

國際替代計量

Bilateral Hydronephrosis and Hydroureters as First Manifestation of Abdominal Actinomycosis: A Case Report

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