Actinomycosis of the gallbladder
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Actinomycosis of the gallbladder is rare and caused by Actinomyces spp. bacteria. It may present as biliary colic, cholecystitis or pancreatitis. It is a mimic of gallbladder carcinoma.
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Actinomycosis is endemic worldwide. It has no predilection for age, gender, ethnicity or climate 4.
Predisposing conditions for actinomycosis include 2:
- diabetes mellitus
- previous surgery
- right upper quadrant pain
- nausea and vomiting
- positive Murphy sign
- palpable mass
- biliary colic
- elevated erythrocyte sedimentation rate (ESR)
- elevated serum alkaline phosphatase
- elevated bilirubin
- elevated serum amylase 5
The Actinomyces are a genus of Gram positive anaerobic filamentous bacteria, which may be normally present in the oral cavity, colon, and urogenital tract 4.
Actinomycosis is a chronic suppurative granulomatous infection depicted by the formation of numerous abscesses.
Findings are non-specific and commonly include 1-4:
- gallbladder wall edema
- diffuse mural thickening of gallbladder
- intraluminal mass lesion
Treatment and prognosis
Cholecystectomy with extended antibiotics for as long as one year is advised for patients with all types of actinomycosis to avoid disease recurrence. Therapy of choice is short course high dose IV, followed by oral, penicillin 2,5.
Drainage may also be required if abscesses are present.
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