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.
Appendicitis
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.
Infective
colitis
This arises from infection with cytomegalovirus and a variety of other
organisms, and can result in severe bloody colitis (Fig.
9.7), 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.
Non-Hodgkin’s
Iymphoma (Fig. 9.8)
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.