CHOLECYSTECTOMY FOR CHOLECYSTITIS IN PATIENTS WITH ACQUIRED-IMMUNE-DEFICIENCY-SYNDROME

Acalculous cholecystitis, a recognized manifestation of acquired immun e deficiency syndrome (AIDS), causes abdominal pain which can be relie ved by cholecystectomy. The indications for cholecystectomy have remai ned undefined, however, because the cholecystitis is usually accompani ed by generalized cholangitis and it is difficult to distinguish the r elative clinical importance of the two problems. Since 1985, we have p erformed cholecystectomy on 8 patients with AIDS who had clinical mani festations of acute cholecystitis associated with a thickening of the gallbladder wall by 5 mm to 12 mm. Two of the 8 had gallstones and 4 h ad associated cholangitis. All had been treated with antibiotics for 2 0 to 180 days before surgery, but physical deterioration had progresse d in every case. At the moment of surgical intervention, 4 patients ha d multiple organ failure. One patient died 3 days postoperatively; but the rest recovered rapidly with resolution of the abdominal pain and sepsis. Two patients died 20 days after surgery due to complications o f AIDS. The remaining 5 died due to AIDS at 6, 9, 10, 12, and 14 month s after surgery. Two of this group developed progressive cholangitis w ith raised serum alkaline phosphatase. Our experience indicates that c holecystectomy should be considered for the treatment of severe and pe rsistent symptoms of hepatobiliary manifestations of AIDS notwithstand ing the presence of cholangitis.