Gastroenterology Research, ISSN 1918-2805 print, 1918-2813 online, Open Access
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Case Report

Volume 3, Number 3, June 2010, pages 134-138

Actinomycosis of the Pancreas: A Case Report and Review

Figures

Figure 1.
Figure 1. Acute pancreatitis with fluid collection.
Figure 2.
Figure 2. Recurrent IPMN cyst of pancreatic tail.
Figure 3.
Figure 3. Pancreatic duct stenosis with distal dilatation.
Figure 4.
Figure 4. Gross specimen of resected remnant pancreas with spleen.
Figure 5.
Figure 5. Branching bacterial filaments at the edge of sulfur granule. Note surrounding inflammation.

Table

Table 1. Reported Cases of Pancreatic Actinomycosis in Literature
 
AuthorPresentationInitial SuspicionBelieved CausePart InvolvedDiagnosed byTreatmentAlive
apancreaticojejunostomy, bpancreatic duct, cpancreaticoduodenectomy, dperiampullary, eTrimethoprim Suflamethoxazole
Parson [21]Obstipation, Sepsis, PeritonismPancreatic necrosisPancreatitisWhole pancreasSurgery – Final diagnosis by bacteriology of wound draining sulfur granulesSodium iodide, Copper sulfate, Colloidal copperDied 3 months later
Ma [8]Abdominal pain, CT showing 3 cm mass in pancreatic head, 9 years post PJa for chronic pancreatitisMalignancy of pancreatic headChronic alcoholic pancreatitis
Prior PJa for pain (9 yrs ago)		HeadEUS guided FNA1 year course of AmoxicillinYes
Harsch [18]Pain, fever, night sweats, CT Pancreatic head lesion and hepatic lesionMalignancy initiallyChronic pancreatitis,
Chronic PDb stenting		HeadUSG guided percutaneous aspiration of liver lesionPenicillin G – ClindamycinYes
Harsch [18] (2nd Patient)Pain, fever, sepsis with pancreatic head lesion on CTMalignancy initially,Chronic pancreatitis
Chronic PDb stenting		HeadStent bacteriology, percutaneous CT guided liver abscess cultureImipenem Clindamycin, vancomycinYes
Jun-Te Hsu [9]2 years after PDc for periampullary carcinoma, mass at PJa siteRecurrent periampd carcinomaPrior Whipple’s procedurePJa siteSurgery – resection of anastomotic mass and reconstruction of PJaPenicillinYes
Halevy [22]Right hypochondrial pain, fever, weight loss, palpable mass RUQPancreatic carcinomaReflux to PDb / ?post appendicitis contiguous spreadHeadLaparotomyPenicillin 600 mg & TMP-SMXeYes
Our patientEpigastric pain, recurrent IPMN in tail of pancreas, 5 years after WhippleRecurrent IPMNPrior Whipple’s procedure,
Chronic pancreatitis		Tail and splenic hilumSurgery, distal pancreatectomy and splenectomyPenicillin – AmoxicillinYes