INTRODUCTION: A clinical dilemma arises when a patient with advanced retroviral disease presents with an acute abdomen. Although it is safe to accept that patients with advanced retroviral disease may develop non-HIV complications, we decided on a clinical trial to determine the nature and prognosis of intra-abdominal catastrophes in patients with the acquired immunodeficiency syndrome (AIDS).
PATIENTS AND METHODS: The study period was April 2003 and June 2004. Inclusion criteria were: *the patient is HIV positive, *the patient presents with either an acute abdomen or bowel obstruction with suspected bowel strangulation, *laparotomy was indicated and performed. A number of patients refused surgery and was therefore excluded from the study. None of the patients were on antiretroviral therapy.
RESULTS: Nine patients were included in the study. Male to female ratio was 5:4. Average age was 32,5 years. 4 Patients presented with clinically advanced AIDS. 2 Patients had pulmonary Tuberculosis. S-albumin was on average 19 g%, which reflected the advanceness of the disease. The operative findings: In 7 patients (77%) the ileum was affected by an inflammatory process resulting in ulceration and necrosis. The core findings were that of chronic necrotizing inflammation affecting mainly the ileo-cecal region. The customary term for this condition is Typhlitis. The pathology: In 6 patients (66%) Tuberculous enteritis was suspected both clinically and pathologically. In one patient acid fast bacilli (AFB) were observed. In another patient endothelial inclusions of cytomegaly virus (CMV) were observed. The outcomes: In spite of optimal patient care, 5 patients (55,5%) died in hospital.
CONCLUSIONS: The AAA is a clinical phenomenon characterized by:
*Typhlitis i.e. a chronic necrotizing inflammation of especially the ileo-cecal region.
*Intestinal Tuberculosis can reasonably be suspected.
*Mortality is high if the patient is subjected to conventional surgery. Other avenues of treatment such as non-operative drainage of the abdominal cavity should be explored.