Gathe J, Glass H, Etter E, Bernal A, Clemmons J, Garland J, Piot D; International Conference on AIDS.
Int Conf AIDS. 1992 Jul 19-24; 8: 82 (abstract no. PuB 7199).
AMI Park Plaza Hospital, Special Diseases Unit, Houston, Texas.
OBJECTIVE: To detail the characteristics of symptomatic gallbladder (GB) disease in AIDS patients. METHODS: Retrospective chart review of 30 randomly selected patients who had surgically managed symptomatic GB disease in 1990 or 1991 and who were followed by at least one of the authors prospectively. RESULTS: All patients had a CD4 count less than 200 and all but 3 had previous AIDS related complications (CMV 20/30; MAIC 9/30; Cryptosporidium 11/30; KS 6/30). On presentation 28/30 had fever and 25/30 had abdominal pain. All had increased liver function tests; the majority also had nausea and vomiting, with symptoms ranging from 24 hours to several weeks. Radiographic studies included ultrasound (27/30), CT scan (21/30) and HIDA Scan (17/30). The most important finding was GB wall thickness (greater than or equal to 3 mm) 23/30 patients; gallstones were found only in 8/30 (27%). HIDA Scan revealed cystic duct obstruction in 9/17. Bile duct enlargement (greater than or equal to 5 mm) was found in 8/30 patients. Surgery was performed in all 30 patients with little perioperative morbidity and only one death within 30 days which was not surgically related. Histologically, chronic inflammation was found in 28/30. A specific diagnosis was made in 13 patients (4 CMV; 5 Cryptosporidium; 2 MAIC; 4 KS; 1 CMV and Cryptosporidium; 1 MAIC and Cryptosporidium). Bacterial cultures were positive in only 4 patients. CONCLUSIONS: Symptomatic GB disease is a complication of patients with AIDS. Presentation is that of acalculus cholecystitis (73%) with radiographic findings commonly showing a thick-walled gallbladder without gallstones. HIDA Scan revealed cystic duct obstruction in 53% of patients; therefore a negative scan does not disprove cholecystitis. Chronic cholecystitis was found most commonly; a specific entity was found in 43% of patients. Perhaps an unrecognized pathogen is responsible for the others. Surgery can be done with minimal perioperative morbidity and leads to symptomatic relief and improves quality of life.
Publication Types:
Keywords:
- Acquired Immunodeficiency Syndrome
- Cholecystitis
- Cholelithiasis
- Cystic Duct
- Gallbladder
- Gallbladder Diseases
- Gallbladder Emptying
- Gallstones
- Humans
- Tomography, X-Ray Computed
- diagnosis
- pathology
- radiography
- radionuclide imaging
- ultrasonography
Other ID:
UI: 102202198
From Meeting Abstracts