RESUMEN
PIP: A 45-year-old Italian woman, who was admitted to the Royal Free Hospital in London, England, with a 14-day history of general malaise, lethargy, epigastric pain after meals, and night sweats, had had an IUD inserted 13 years earlier which had not been changed. The patient was pyrexial on examination; she had a temperature of 38 degrees Centigrade but no jaundice or enlarged lymph nodes. There was mild epigastric tenderness, and a tender indurated rectal stricture involving the posterior fornix of the vagina was palpable on pelvic examination. The rectal stricture was confirmed on sigmoidoscopy. The biopsy revealed a chronic inflammatory cell infiltrate with lymphocytes, extending from the submucosa through to the muscularis mucosae. A preoperative barium enema showed a long irregular rectal stricture. A large mass of inflammatory tissue was found adherent to the uterus, rectum, fallopian tubes, and ovaries at laparotomy. Bilateral retrograde ureterograms showed complete obstructions of the left ureter at 5 cm and a long irregular stricture was seen at the same level on the right. The histological examination revealed actinomycosis of the uterus, fallopian tubes, and ovaries. 12 weeks postoperatively the patient was well; sigmoidoscopy to 25 cm showed complete resolution of the rectal stricture. The antibiotic treatment was stopped. The most likely source of this patient's actinomycosis was the IUD for the relationship between the two is well established. In this patient a prolonged course of antibiotics proved effective in treating the infection.^ieng