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Jumat, 07 Agustus 2009

Explorative laparatomy for diagnosis of abdominal painful syndromes in HIV positive patients.

Angelici A, Palumbo P, Piermattei A, Toma L, Romani R, Delia S; International Conference on AIDS.

Int Conf AIDS. 1993 Jun 6-11; 9: 447 (abstract no. PO-B19-1869).

IV Surgical Department, Univ. La Sapienza, Rome, Italy.

Abdominal pain may often represent the first symptom of important opportunistic conditions related to HIV infection. In particular, infections by atypical mycobacteria, mainly belonging to the Mycobacterium avium complex (MAC), are a frequent cause of abdominal painful syndromes which usually arise difficult diagnostic and therapeutic problems. Diagnosis is usually made on the basis of a positive blood culture, but sometimes ecography or TC-guided biopsy of deep lymph nodes (retroperitoneal, spleen or liver hilum, mesenteric root) may be required. However, the material obtained with the latter approach may not be adequate for diagnosis and surgery may be the only mean to the identification of the etiologic agent. In the present study we report data about 4 patients with MAC infection in which diagnosis could only be made by surgical approach. Two patients underwent emergency explorative laparotomy for acute abdomen and MAC intestinal infection was diagnosed; in the other 2 cases elective surgery was performed and biopsy of lymph nodes revealed MAC lymphadenopathy. Diagnostic imaging limits and surgical risks in these patients, who often will not take much advantage from specific treatment, will be discussed.

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