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Pelvic actinomycosis masquerading as an acute abdomen from a small bowel perforation.

Pelvic actinomycosis is an extremely rare disease which may complicate long-term intrauterine contraceptive device (IUCD) use. Its timely recognition is important as clinical and radiological signs may mimic other intra-abdominal pathology and lead to radical and unnecessary surgery. We report a 50-year-old woman with pelvic actinomycosis resulting from a neglected intrauterine device, which was left in place for 20 years. The signs and symptoms at presentation were consistent with acute peritonitis from a perforated viscus. A perforated segment of the small bowel was suspected intraoperatively and resection was performed. The diagnosis was only revealed on subsequent histopathological examination of the surgical specimen. A high index of suspicion for this rare but devastating condition must be maintained in any woman with an IUCD and who presents with a surgical abdomen. Diligence in replacing IUCDs at recommended intervals and adherence to "missing threads" protocols may prevent these sequelae.