We report herein a rare case of ureteral and sigmoid obstruction caused by pelvic
actinomycosis in a patient fitted with an
intrauterine contraceptive device (IUCD). A 63-year-old Japanese woman was admitted complaining of lower
abdominal pain and slight
fever continuing for a month. She had a history of IUCD insertion 30 years previously and had been menopausal for the past 10 years. Ultrasonography and CT scan revealed a solid pelvic mass involving the uterus, sigmoid colon, urinary bladder, and right ureter. The IUCD was detected in the uterine cavity. Right
hydronephrosis and hydroureter due to an obstruction of the distal ureter and the extensive
stenosis of the sigmoid colon were also observed. Blood analysis showed
leukocytosis,
thrombocytosis, and elevated
C-reactive protein levels. Although pathological and microbiological analysis of the removed IUCD showed negative results for
Actinomyces infection, these findings suggested a pelvic
abscess caused by
actinomycosis. Benzyl
penicillin administration was started immediately. Total
hysterectomy, bilateral
salpingo-oophorectomy, and lysis of adhesion around the ureter were performed.
Actinomycosis was diagnosed based on histologic examination. The patient's postoperative course was uneventful except for persistent mild hydroureter and
hydronephrosis. The patient is now healthy without evidence of recurrent
Actinomyces infection 1 year
after treatment. As shown in the present case, pelvic
actinomycosis should be considered as a cause of
pelvic inflammatory disease in IUCD users, even though Actinomyces was not detected on the IUCD.