EMERGENT ABDOMINAL-SURGERY IN AIDS - EXPERIENCE IN SAN-FRANCISCO

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.