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Pelvic actinomycosis is a rare, granulomatous disease, caused by the gram-positive anaerobic bacteria, Actinomyces. It is usually associated with recent abdominopelvic surgery or intrauterine contraceptive device placement. The diagnosis is difficult because of the similarity with malignancy, inflammatory bowel disease, and tuberculosis. Although intrauterine device related actinomycosis is considered a well-documented diagnosis, there are intermittent case reports of unusual presentations. Appropriate image survey can aid clinicians in its diagnosis and treatment of pelvic actinomycosis and further prevent unnecessary invasive intervention. Here the authors present a case of suspected pelvic actinomycosis with abdominal wall involvement supported with images and describe the clinical manifestations. The disease with abdominal wall involvement and treated with empirical antibiotics administration only has yet to be reported.