The acute abdomen in AIDS
Abdominal pain occurs in over 10 per cent of all AIDS patients. However, only 5 per cent of AIDS patients with abdominal pain require surgery, and this includes a small group of patients who develop acute abdominal symptoms where emergency laparotomy is necessary. The principal indications for emergency laparotomy in the AIDS patient are as follows.
This presents as in the normal population. Where the signs and symptoms suggest a diagnosis of appendicitis in an HIVpositive patient, then appendicectomy should be carried out and the postoperative course is similar to the non-HIV patient.
This arises from infection with cytomegalovirus and a variety of other organisms, and can result in severe bloody colitis , toxic megacolon or colonic perforation which may be life threatening.
Mycobacterium avium intracellulare infection
This produces an illness in which generalised symptoms are more prominent with vague abdominal pain associated with fever and marrow suppression. Laparotomy is better avoided in these patients if possible. The diagnosis can be made by marrow aspirate or needle biopsy of enlarged lymph nodes.
Diagnostic laparotomy to obtain lymph node tissue for histological examination should be avoided where possible. Occasionally, patients undergoing chemotherapy treatment for non-Hodgkin’s lymphoma develop acute abdominal symptoms, for example, due to small bowel perforation at the site of tumour necrosis. The general experience with emergency laparotomy in the HIV-positive individual in this situation has been disappointing, and it is probably better avoided.
Overall, where conventional clinical criteria indicate the need for emergency laparotomy, the results in the HIVpositive patient suggest a 10 per cent perioperative mortality with a median survival of about 6 months following emergency surgery. Thus, this policy does seem to offer some additional life to these unfortunate patients.
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