The Acute Abdomen in the Immunocompromised Host

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

“…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).…”

“…Ten patients (seven male and three female) underwent emergency laparotomy; six operations were for perforated viscus or peritonitis, two for intestinal obstruction, one for toxic condition of the megacolon and the other for hemo- (1) CMV colitis (3) tonitis (6) Acute appendicitis (1) MA1 enteritis (1) Acute cholecystitis (1) Spontaneous splenic rupture (1) (non-Hodgkin's lymphoma) GI non-Hodgkin's lymphoma (1) GI Kaposi's sarcoma (1) Hemoperitoneum ( peritoneum. Laparotomy findings and definite diagnoses of these patients are reported in detail in Table IV.…”

“…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.…”

Acute surgical abdomen in an immunocompromised patient

“…Immunocompromised patients are a heterogeneous group that includes not only those on high-dose corticosteroids, but also people at extremes of age, transplant recipients, cancer patients who are receiving chemotherapy, and patients with acquired immunodeficiency syndrome. 1,2 Because of a blunted systemic inflammatory response, typical manifestations of abdominal sepsis such as fevers, tachycardia, peritonism, leukocytosis and high CRP may be absent or delayed. 2,3 Overreliance on these parameters may lead to misdiagnosis and undertreatment resulting in increased patient morbidity and mortality.…”