Appendicitis in acquired immunodeficiency syndrome.
Reports in the surgical literature are few regarding common intra-abdominal disease processes, such as gallstone disease or appendicitis, in patients with AIDS and instead have focused on AIDS-related intra-abdominal diseases that infrequently require surgical intervention unless complicated by bleeding, obstruction, or perforation. A literature review for appendicitis in AIDS patients revealed only 30 well-documented cases drawn from 13 studies, with a 40% perforation rate and frequent delays and errors in diagnosis. A 7-year experience with 28 patients with appendicitis and AIDS from 4 urban San Francisco hospitals is reviewed. There were no perioperative deaths and an 18% postoperative complication rate. Five patients (18%) were found to have normal appendices with other intra-abdominal pathology, and an AIDS-related etiology for appendicitis was discovered in 7 of 23 patients with appendicitis (30%). With the exception of diffuse versus localized abdominal pain, no preoperative symptom or sign was useful in differentiating AIDS-related and non-AIDS-related disease. Aggressive use of ultrasound and abdominal computed tomographic scanning, along with early surgical intervention, is recommended.
Whitney
T M
TM
Department of Surgery, University of California, San Francisco 94143-0807.
Macho
J R
JR
Russell
T R
TR
Bossart
K J
KJ
Heer
F W
FW
Schecter
W P
WP
D017088:AIDS-Related Opportunistic Infections / Q000150:complications; D000163:Acquired Immunodeficiency Syndrome / Q000150:complications*; D000328:Adult; D001064:Appendicitis / Q000150:complications* / Q000503:physiopathology / Q000601:surgery; D003092:Colitis / Q000150:complications / Q000382:microbiology; D003586:Cytomegalovirus Infections / Q000150:complications; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D013997:Time Factors