Emergent abdominal surgery in AIDS: experience in San Francisco.
Several recent reviews have suggested that aggressive surgical intervention can reduce morbidity and mortality associated with intra-abdominal crises in AIDS patients. We reviewed our experience with 57 AIDS patients with 63 emergent laparotomies performed at 4 hospitals affiliated with the University of California in San Francisco. Fifty-five patients (96%) were homosexual men. Thirty-nine (68%) had been treated for an opportunistic infection. Indications for exploration included right lower quadrant pain consistent with appendicitis in 24 patients (38%), visceral perforation or obstruction in 11 (17%), right upper quadrant pain in 9 (14%), diffuse peritonitis in 8 (13%), and uncontrollable hemorrhage in 8 (13%). Perioperative mortality was 12% (7/57). Fifteen patients (26%) suffered major complications including pneumonia, sepsis, multi-organ failure, and intra-abdominal abscess. Forty-five of 50 survivors (90%) were receiving some type of chronic antimicrobial or antineoplastic chemotherapy, compared to only 2 of the 7 patients who died (28.6%) (P < 0.001). Lack of ongoing prophylactic treatment for AIDS-related disease, active opportunistic infections, Walter Reed VI classification, and ongoing sepsis at the time of exploration were noted to be associated with increased morbidity and mortality.
Whitney
T M
TM
Department of Surgery, University of California, San Francisco.
Brunel
W
W
Russell
T R
TR
Bossart
K J
KJ
Schecter
W P
WP
D000006:Abdomen, Acute / Q000150:complications / Q000401:mortality / Q000601:surgery*; D000163:Acquired Immunodeficiency Syndrome / Q000150:complications*; D004630:Emergencies; D006801:Humans; D007813:Laparotomy / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D012189:Retrospective Studies