The presence of infection with the HIV-1 RNA retrovirus, acquired immunodeficiency related complex, or full-blown acquired immunodeficiency syndrome is not a contraindication to major abdominal surgery. Judgment should be exercised, however, when the patient with AIDS has multiple opportunistic diseases in association with a CD4 T-cell count less than 200/mm3. As in patients without these disorders, indications for laparotomy include emergency abdominal conditions (perforation of the gastrointestinal tract, intestinal infarction, intra-abdominal hemorrhage); urgent abdominal conditions (acute inflammation, obstruction of the small or large intestine, acute gynecological lesion); and diagnosis and treatment of an abdominal malignancy, fever of unknown origin, or abdominal pain of unknown cause.

The diagnostic problem in immunocompromised patients with HIV infection and abdominal pain of unknown cause is the increased incidence of conditions related to the presence of unusual infectious agents (Candida, Histoplasma, Mycobacterium avium, Cryptococcus, cytomegalovirus) or uncommon malignancies (non-Hodgkin's lymphoma, Kaposi's sarcoma). Because of the hepatosplenomegaly, intra-abdominal inflammatory masses, retroperitoneal lymphadenopathy, and enterocolitis related to the processes listed above, diagnostic dilemmas are common in these patients.

Modestly invasive diagnostic procedures such as laparoscopy should be considered in patients with HIV infection and abdominal pain that is not typical of the usual emergent or urgent conditions requiring laparotomy.

1. If diarrhea is present, search for an infectious cause of the pain and observe the abdomen.

2. In patients with organomegaly or ileus, abdominal pain may be related to these problems.

3. Common acute abdominal conditions (appendicitis, cholecystitis) occur in patients with HIV infection and should be treated appropriately.

4. […]