Several recent reviews have suggested that aggressive surgical interve
ntion can reduce morbidity and mortality associated with intra-abdomin
al crises in AIDS patients. We reviewed our experience with 57 AIDS pa
tients with 63 emergrent laparotomies perforated at 4 hospitals affili
ated with the University of California in San Francisco. Fifty-five pa
tients (96%) were homosexual men. Thirty-nine (68%) had been treated f
or an opportunistic infection. Indications for exploration included ri
ght lower quadrant pain consistent with appendicitis in 24 patients (3
8%), visceral perforation or obstruction in 11 (17%), right upper quad
rant pain in 9 (14%), diffuse peritonitis in 8 (13%), and uncontrollab
le hemorrhage in 8 (13%). Perioperative mortality was 12% (7/57). Fift
een patients (26%) suffered major complications including pneumonia, s
epsis, 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 w
ho died (28.6%) (P < 0.001). Lack of ongoing prophylactic treatment fo
r AIDS-related disease, active opportunistic infections, Walter Reed V
I classification, and ongoing sepsis at the time of exploration were n
oted to be associated with increased morbidity and mortality.