title: Bile duct-duodenal fistula caused by AIDS/HIV-associated tuberculosis.
abstract: Although infrequent, digestive fistulae in HIV/AIDS patients have been reported throughout the digestive tract from the esophagus to the anus, with predominance of esophageal fistulae. AIDS/HIV-associated opportunistic infections may invade the digestive system and lead to fistula formation. Tuberculosis is the most common infection associated with these esophageal fistulae. We report here one case of bile duct-duodenal fistula in a female AIDS patient with associated abdominal Mycobacterium tuberculosis infection compromising lymph nodes of the hepatic pedicle where the fistula was found. According to the reviewed literature, this is the third case of bile duct-duodenal fistula associated with abdominal tuberculosis in AIDS patient, and the first where both the fistula and the tuberculosis infection were diagnosed at laparotomy for acute abdomen. Whether the AIDS patient with abdominal pain needs or not a laparotomy to treat an infectious disease is often a difficult matter for the surgeon to decide, as most of the times appropriate medical treatment will bring more benefit.
authors.affiliation: Emergency Surgery Service, Hospital das Clínicas, Faculty of Medicine, University of São Paulo, São Paulo/SP, Brazil.
authors.forename: Carlos
authors.initials: C
authors.lastname: Patino
authors.forename: Belchor
authors.initials: B
authors.lastname: Fontes
authors.forename: Renato Sergio
authors.initials: RS
authors.lastname: Poggetti
authors.forename: Cornelius
authors.initials: C
authors.lastname: Mitteldorf
authors.forename: Conrado
authors.initials: C
authors.lastname: Alvarenga
authors.forename: Dario
authors.initials: D
authors.lastname: Birolini
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000150:complications*; D000163:Acquired Immunodeficiency Syndrome / Q000150:complications; D001649:Bile Duct Diseases / Q000209:etiology*; D001658:Biliary Fistula / Q000209:etiology*; D004378:Duodenal Diseases / Q000209:etiology*; D005260:Female; D006801:Humans; D007412:Intestinal Fistula / Q000209:etiology*; D007813:Laparotomy; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D014376:Tuberculosis / Q000150:complications*