골반 방선균증의 치료에 대한 임상적 고찰

초록

Objective: Pelvic actinomycosis is a rare disease, which make chronic granulomatous suppurative pelvic abscess caused by an anaerobic Gram positive organism Actinomyces israelii usually associated with intra-uterine devices, and difficult to diagnose exactly before operation. Pelvic actinomycosis is frequently confused with gynecologic malignancy, leading to misdiagnosis and overtreatment. We experienced 8 cases of pelvic actinomycosis and provide the advice for treatment of pelvic actinomycosis Methods: We reviewed retrospectively the medical chart of 8 cases which have visited to Department of Obstetrics and Gynecology, College of Medicine, Anam Hospital, Korea University for pelvic actinomycosis from January 1999 to January 2007. Results: The mean age of patients was 45.2 years old. Main symptoms were abdominal pain, vaginal bleeding, vaginal discharge, dysmenorrhea and fever with chilling. All cases have used the intrauterine devices for 5-20 years. 3 cases were diagnosed preoperatively by endometrial biopsy, punch biopsy, or empirically, and the others suspected to tuboovarian abscess or malignancy, and then their diagnoses were conformed by operation. 5 cases were treated by operation following antibiotics therapy, and 2 cases by antibiotics without operation, and 1 case by antibiotics therapy following operation. All cases were completely cured. Conclusion: In the treatment of pelvic actinomycosis, most important point is making the diagnosis before operation for decreasing complication such as bowel, bladder, and other pelvic organ injury. Inevitably, if the diagnosis was established by operation, postoperative high-dose antibiotic therapy was needed for several months.

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