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DOI: 10.1055/s-2007-988580
Schmerzen nach laparoskopischem Y-Roux-Bypass bei ausgeprägter Adipositas
Introduction: Abdominal actinomycosis is an uncommon disease caused by different Actinomyces species. Nevertheless it should be considered in the differential diagnosis of tumour-like abdominal masses. We report a case of abdominal actinomycosis following laparoscopic Roux-Y-gastric-bypass.
Case presentation: A 33-year-old, morbidity obese woman (138kg, 171cm, BMI 47.0kg/m2) underwent a laparoscopic Roux-Y-gastric-bypass in November 2004. There were no complications and the perioperative course was uneventful. The patient presented 18 months later with a history of recurrent intermitted pain of mild severity in the upper region of the abdomen. The pain was associated with nausea, vomiting and bloating and worsened after eating.
Results: A CT-scan and Magnetic resonance imaging (MRI) of the abdomen were performed, which revealed a wall thickening in the transverse colon and a solid, not homogenous tumor near the liver. Endoscopic evaluation showed an area of vessel inflammation in the wall of the transverse colon without a stenosis. Therefore a sonography-guided biopsy of the tumor was performed.
Cytopathological examination revealed an actinomycosis. Thus, a therapy with penicillin was started. In the following time the infection parameters decreased, but the symptoms persisted and the decision was made to operate the patient for resection of the abdominal mass. During the operation multiple masses were found in the middle of the upper abdomen and nearly 90% percent of the masses could be removed. The histological analysis of the resected masses showed a fibro-productive inflammation with an actinomycotic etiology. The antibiotic therapy was continued with intravenous penicillin for a week and followed by oral penicillin for another 6 months.
The patient was seen after 3 and 6 months and she was completely asymptomatic.
Conclusion: We report an extremely rare complication after laparoscopic Roux-Y-gastric-bypass. Actinomycosis must be considered in the differential diagnosis of patients with abdominal mass, wall thickening of the intestine and with symptoms such as abdominal pain following bariatric surgery, even many years after the intervention.