Journal of Okayama Medical Association
Published by Okayama Medical Association

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抗菌化学療法で保存的に閉鎖した放線菌症による 難治性皮膚直腸膀胱瘻の1例

Katsura, Yuki Department of Surgery, Hiroshima City Hiroshima Citizens Hospital
Matsukawa, Hiroyoshi Department of Surgery, Hiroshima City Hiroshima Citizens Hospital
Kato, Takuya Department of Surgery, Hiroshima City Hiroshima Citizens Hospital
Sugihara, Masahiro Department of Surgery, Hiroshima City Hiroshima Citizens Hospital
Ojima, Yasutomo Department of Surgery, Hiroshima City Hiroshima Citizens Hospital
Shiozaki, Shigehiro Department of Surgery, Hiroshima City Hiroshima Citizens Hospital
Abstract
The patient was a 35-year-old Japanese man diagnosed with appendicitis with abscess formation. An appendectomy was performed, but a refractory surgical wound infection developed, and eventually a cutaneous-rectovesical fistula was detected. In a review of the first-time CT scan, a small high-density construction resembling a bone from a fish was detected in the ileum. The histopathological examination revealed granules of actinomyces. These findings suggested that abdominal actinomycosis due to intestinal mucosal breakage by the fish bone caused the secondary appendicitis, and that after the appendectomy, residual actinomyces caused the cutaneous-rectovesical fistula. After the diagnosis, total parenteral nutrition and a long-term administration of antibiotics improved the patient's clinical symptoms, and the fistula closed within a month. Antibiotics were administered for 6 months, and there has been no recurrence for 6-1/2 years. Because actinomycosis is difficult to diagnose based on the typical clinical features, a direct identification of the infecting organism from a tissue sample or from sulfur granules is required for the definitive diagnosis. Actinomyces is also known to cause fistula formation, and intestinal penetration caused by a fish bone may indicate abdominal actinomycosis. A rectovesical fistula requires surgical intervention in most cases, but in cases caused by abdominal actinomycosis, such a fistula may be cured by conservative therapy, as in our patient's case. It is important to consider the possibility of actinomycosis when a refractory rectovesical fistula is observed.
Keywords
放線菌症 (actinomycosis)
皮膚直腸膀胱瘻 (cutaneous-rectovesical fistula)
急性虫垂炎 (appendicitis)
Note
症例報告(Case Reports)
ISSN
0030-1558
NCID
AN00032489
DOI