Emergency colectomy for cytomegalovirus ileocolitis in patients with the acquired immune deficiency syndrome

Abstract

The charts of all patients with the acquired immune deficiency syndrome (AIDS) who underwent emergency intra-abdominal surgery between January 1981 and July 1987 were reviewed. Eleven AIDS patients underwent 13 emergency laparotomies. Seven of these patients (64 percent) had cytomegalovirus (CMV) ileocolitis as the pathologic process requiring emergent surgical intervention. Four patients had hemorrhagic CMV proctocolitis and three had perforations of CMV ulcers of the ileum or rectosigmoid. The operations performed included three subtotal colectomies, two segmental resections, and two diverting stomas. The postoperative mortality rate in the CMV group was 28 percent at one day, 71 percent at one month, and 86 percent at six months. Furthermore, CMV ileocolonic pathology was directly responsible for 70 percent of the deaths in AIDS patients who underwent emergent exploratory laparotomy.

Severe Abdominal Pain in Patients with AIDS: Frequency, Clinical Aspects, Causes, and Outcome

“…Postoperative prognosis, however, was very poor, since we found a 1-month postoperative mortality of 60%. These results are in agreement with those of Wexner et al (5) and Wilson et al (25), who reported 1-month mortalities of 71% and 46%, respectively, in their series of patients undergoing emergency laparotomy for abdominal pain. However, it is possible that earlier surgical intervention, before perforation and peritonitis intervene, and the use of zidovudine or ddI may ameliorate the postoperative prognosis of these patients, as suggested by recent experience (7).…”

“…With regard to the causes of abdominal pain, it is not surprising that HIV-related disorders clearly predominated over non-AIDS-related diseases in this population; this concurs with the results of previous experiences, all showing that most of the disorders responsible for pain are strictly associated with the immunocompromised state and are often infective (2)(3)(4)(5)(6)(7)(8)(9). The commonest single cause of severe pain in the present series was GI NHL; the GI tumor always occurred in patients who also had lymphoma outside the gastrointestinal tract.…”

“…In addition, and differing from other key symptoms such as odynophagia/dysphagia and diarrhea, the causes of which have been extensively examined in large-scale studies (17)(18)(19)(20), the entire spectrum of pathologic conditions responsible for abdominal pain in the context of AIDS has not yet been well defined; this is due mainly to the fact that existing data derive almost exclusively from case histories or surgical series describing only those patients who have undergone emergency surgical procedures (2)(3)(4)(5)(6)(7)(8)(9).…”

“…Most of the existing data, indeed, derive from case histories of patients referred for emergency laparotomy or small surgical series describing only patients who underwent operative procedures (2)(3)(4)(5)(6)(7)(8)(9). Therefore, the true incidence of this condition in the general AIDS population remains unknown.…”

Increased Risk of Wound Complications and Poor Healing following Laparotomy in HIV-Seropositive and AIDS Patients

“…In order to establish whether HIV and AIDS patients are subject to an increased risk of wound complications and poor healing, a wound other than that of the anorectal canal requires investigation. Several authors have described a high rate of wound complications and problems with wound healing following laparotomy [16, 17, 18, 19, 20]. These observations in various reports require clarification and the prognostic factors, both clinical and immunological, which may lead to poor healing need to be defined.…”