Abdominal wall actinomycosis associated with use of an intrauterine device: a case report.

Described is the second reported case of isolated abdominal wall actinomycosis associated with use of an IUD. The patient a 24-year-old white woman presented with lower abdominal pain dysuria urgency and frequency. Ultrasonography revealed a complex mass in the left lower quadrant of the abdomen that was separate from the uterus left ovary and tube. At laparotomy the patient was found to have an anterior abdominal wall abscess and there was free pus within the abdomen. The omentum was inflamed and adherent to the anterior abdominal wall. The appendix uterus ovaries and tubes were not involved in the inflammatory process. Histologic examination of the omentum demonstrated the typical actinomycotic picture of gram-positive filamentous bacteria within the mass and club-like extensions beyond the periphery of the mass. The patient had a copper-7 IUD in place. The only other reported such case also involved an IUD user. That patient had an isolated anterior wall abscess caused by Actinomyces. The fallopian tubes ovaries appendix omentum and intestines were normal. The possibility of abdominal wall actinomycosis should be considered in IUD users who present with intra-abdominal abscesses of unknown etiology.