Emergency colectomy for cytomegalovirus ileocolitis in patients with the acquired immune deficiency syndrome.

The charts of all patients with the acquired immune deficiency syndrome (AIDS) who underwent emergency intra-abdominal surgery between January 1981 and July 1987 were reviewed. Eleven AIDS patients underwent 13 emergency laparotomies. Seven of these patients (64 percent) had cytomegalovirus (CMV) ileocolitis as the pathologic process requiring emergent surgical intervention. Four patients had hemorrhagic CMV proctocolitis and three had perforations of CMV ulcers of the ileum or rectosigmoid. The operations performed included three subtotal colectomies, two segmental resections, and two diverting stomas. The postoperative mortality rate in the CMV group was 28 percent at one day, 71 percent at one month, and 86 percent at six months. Furthermore, CMV ileocolonic pathology was directly responsible for 70 percent of the deaths in AIDS patients who underwent emergent exploratory laparotomy.

The surgical management of anorectal diseases in AIDS and pre-AIDS patients.

The charts of 340 patients with Acquired Immunodeficiency Syndrome (AIDS), AIDS-related complex (ARC), or AIDS-prodrome (AIDS-P), treated between January 1982 and April 1986 at the Roosevelt Division of the St. Luke's-Roosevelt Hospital Center, were reviewed. The incidence of anorectal disease was 34 percent. Fifty-two patients (15 percent) presented with anorectal complaints prior to the diagnosis of AIDS, ARC, or AIDS-P. Over 50 percent of these patients were dead within 7.4 months. Fifty-one patients (15 percent) underwent 73 anorectal surgical procedures. Twenty-two of these patients (43 percent) were dead within six months, and only six patients had satisfactory wound healing 30 days after surgery. In addition to an 88 percent rate of poor healing, there was a 16 percent rate of major complications. Identification of these high-risk groups prior to any anorectal surgery is imperative to avoid unacceptable surgical complications. Aggressive surgical intervention should be reserved only for patients who did not fall into the high-risk groups presented.

The diagnosis and treatment of acute appendicitis in the aged.

Since the turn of the century, the elderly population, particularly those over the age of 80, has been increasing steadily. Consequently, the surgeon will be confronted frequently with the diagnostic challenge of acute appendicitis in this population. Over the past ten years, 13 patients over the age of 80 were treated for acute appendicitis at the St. Lukes-Roosevelt Hospital Center. The mean duration of symptoms was 2.4 days; all patients complained of abdominal pain, with 72 percent of patients having right lower quadrant involvement. Ninety-two percent had perforated prior to surgery, and 23 percent did not survive the disease. This high mortality rate is attributed to both a delay in presentation to the physician and a further delay in proper treatment due to misdiagnosis. This is a disease with which every physician must be familiar and be continually vigilant, as correct diagnosis and prompt treatment are the keys to averting high morbidity and mortality rates.

Effects of ileal interposition on body weight and intestinal morphology in dogs.

Interposition of a segment of terminal ileum into the proximal jejunum has been shown to cause weight loss and hypertrophy of the pancreas and intestines of rats. To further evaluate the potential of ileal interposition as an anti-obesity procedure, weight loss, liver histology and intestinal morphology were studied in normal adult mongrel dogs. A 40 to 45-cm segment of distal ileum was transposed isoperistaltically on its vascular pedicle to the proximal jejunum (n = 14). Control dogs (n = 4) underwent transection and reanastomosis without interposition. Interposition resulted in a mean weight loss of 3.9 kg or 16 percent of body weight, over a 12-week period compared to a mean gain of 2.6 kg (11 percent of preop.) in the controls (P less than 0.025). Liver histology (n = 3) showed minimal fatty infiltration in one dog. Grossly, the transposed ileal segment did not show any consistent elongation or thickening of the bowel wall. Microscopically, there was complete jejunalization of the mucosa of the ileal segment which was indistinguishable histologically from the adjacent jejunal mucosa. Because of the variability of the weight response (-8.6 to +0.9 kg), further studies are required to evaluate the potential of this experimental procedure to achieve weight loss.