Background: Actinomyces is a rare cause of biliary obstruction. Past case reports have discussed this rare pathology, but there is a gap in the literature for surgical management of this disease. Case Report: A woman in her 50s with a history of laparoscopic cholecystectomy presented with recurrent right upper quadrant pain and recurrent biliary obstruction, relieved by multiple rounds of endoscopic retrograde cholangiopancreatographies. Surgical treatment was offered and the patient underwent Roux-en-Y hepaticojejunostomy. Pathology revealed Actinomyces and postoperative antibiotics were given. The patient continued to report symptom relief on 6 months follow-up. Discussion: While Actinomyces is a rare presentation of biliary obstruction, biliary reconstruction can be offered in patients who fail endoscopic decompression and antibiotics. In cases of recurrent biliary obstruction, culture and brushing of the biliary tree may reveal this rare pathology. Conclusions: In patients with recurrent biliary obstruction caused by Actinomyces, surgical reconstruction of the affected biliary tree and antibiotics can offer patients long-lasting symptoms relief.
Poian et al. (Wed,) studied this question.