GASTROINTESTINAL PROBLEMS IN THE IMMUNOCOMPROMISED HOST - A REVIEW FOR SURGEONS

As the immunocompromised patient population grows, the gastrointestina l surgeon is increasingly called upon to make complex diagnostic and t herapeutic decisions. The surgeon should first identify the patient as immuno-compromised and then categorize the probable degree of immunoc ompromise as mild, moderate, or severe. Mildly immunocompromised patie nts tend to present late and with minimal symptoms, but the disease en tities are the same ones seen in the general population. Moderately an d severely immunocompromised patients may also develop the usual surgi cal problems, but the differential diagnosis is expanded to include co mplications of the immunocompromised state or complications of the und erlying problem which caused the immune compromise. The expanded diffe rential diagnosis includes infections with atypical organisms, opportu nistic neoplasms, neutropenic enterocolitis, complications of medicati ons, and forms of biliary tract disease not seen in the general popula tion. Advances in oncology, transplantation, and the treatment of AIDS , have extended the life expectancy of these patients and increased th e immunocompromised population. Prompt appropriate operative therapy m ay be lifesaving when surgical complications develop.