Acute Abdomen and HIV Infection

Abdominal pain in the HIV-infected patient is a common complaint which constitutes a complicated diagnostic and therapeutic problem. Even though the need for surgical intervention in the HIV/AIDS patient with abdominal complaints is low, the general surgeon will often be called upon to evaluate HIV-infected patients, as a result of the complexity in the interpretation of clinical findings. Once consulted, the surgeon’s dilemma is in distinguishing conditions which do not require surgery from surgically treatable pathology and, above all, the true surgical emergencies. Emergent abdominal operation by itself predisposes the AIDS patient to an increased mortality risk 1,2,3,4. On the other hand, delayed diagnosis and late surgical exploration result in increased morbidity and mortality 5. Although profound immunodeficiency is associated with poor prognosis, asymptomatic HIV-infected patients recover well from surgery and do not appear to suffer delayed healing 6,7. Yet, with new antiviral therapy the operative mortality has dropped as much as necessary for emergency abdominal surgery and the riskbenefit analysis is now more in favour of laparotomy 5,8,9.