Abdominal actinomycosis mimicking colonic tumor with the invasion of the small bowel and of the anterior abdominal wall

Actinomycosis is a chronic; pseudotumoral with suppurated areas disease caused by an anaerobic grampositive organismand has been surnamed “the great mime” [1]. An 82 years old Caucasian female presented in our department with signs of a transverse colon tumor that appeared to infiltrate the left rectus muscle posterior sheet. CT scan, Barium enema, colonoscopy could not settle the diagnosis and laparotomy was performed. The tumor was formed by transverse colon and his mesocolon, left abdominal rectus muscle above the umbilicus on a distance of 5 cm, great omentum and a jejunal loop. En bloc resection was done. The median incision was prolonged to the left at the level of umbilical scar, about 2 cm below the inferior limit of the tumor, same procedure was performed related to the cranial limit of the tumor. The transverse colon was resected with consecutive end-to-end colo-colic anastomosis. The jejunal loop was resected with jejuno-jejunal end-to-end anastomosis. At the end of the procedure the left rectus muscle sheets were sutured with separate sutures.Actinomycosisisraelii was the pathogen found at pathology report. Despite refusal of antibiotic therapy the patient didn’t had any recurrences after a follow-up of four years. Surgery has the main role in diagnosing and treating abdominal actinomycosis. Index terms – Abdominal actinomycosis, mimicking colon tumor.