A CASE OF RECTAL STRICTURE DUE TO PELVIC ACTINOMYCOSIS ASSOCIATED WITH AN INTRAUTERINE DEVICE

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  • 子宮内避妊具が原因と考えられた骨盤放線菌症による直腸狭窄の1例

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Abstract

A 50-year-old woman was seen at the department of gynecology in our hospital because of severe lower abdonimal pain and fever. She had been inserted an intrauterine device (IUD) at the age of 25 and exchanged every 3-4 years until the age of 40, however, she had let it alone without exchange thereafter. Abdominal CT scan revealed thickening of the rectal wall and a rectal tumor shadow, and then she was transferred to our department of surgery. Inflammatory disease of the rectum was suspected and she was operated on. At laparotomy, the bladder, sigmoid colon and cecum were firmly adhered to the anterior surface of the uterine, suggestive of inflammation, and the rectal wall showed inflammatory hypertrophy. A total hysterectomy, an adnexectomy, and a low anterior resection of the rectum were carried out. On the resected material, the IUD was identified in the lumen of the uterine, and the posterior wall of the uterine became thin to form a mass with the rectal anterior wall. Histopathologically abscess formation was prominent at the uterine and right adnexa and grains of Actinomycetes were identified in them. Accordingly rectal stricture caused by infiltrated inflammation of pelvic actinomycosis was diagnosed.<br> This disease can be treated by internal treatments so that it must be kept in mind as a probable diagnosis for rectal stricture of unknown origin.

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