Overview
AIDS combined appendicitis refers to appendicitis in AIDS patients, the symptoms are similar to ordinary appendicitis, but due to the severe suppression of the autoimmune function of AIDS patients, the pathological changes in the appendix are different from those of immunocompetent patients, which manifests itself as an insignificant increase in the white blood cell count or even lower than the normal level, which often delays the diagnosis and treatment, and the rate of confirmation of the diagnosis is high in laparoscopy, and the diagnosis should be confirmed and treated by surgery as early as possible.
Etiology
Due to the suppressed immune function, the appendix of AIDS patients is more susceptible to bacterial infection than that of normal patients, resulting in appendicitis.
Symptoms
Clinical manifestations are similar to those of immunocompetent patients, with typical metastatic right lower abdominal pain, which may be accompanied by nausea, vomiting and often low-grade fever. There may be pressure, rebound pain and muscle tension in the right lower abdomen.
Examination
1. Laboratory tests
HIV antibody test shows positive, white blood cell count is not obviously elevated or even lower than normal.
2. Imaging examination
X-ray, CT, color ultrasound and other imaging tests are not necessary, but can be used when the diagnosis is uncertain, which can help the diagnosis.
3. Laparoscopy
In recent years, laparoscopy has been applied to the diagnosis and treatment of appendicitis, and the diagnosis rate of laparoscopy is high.
Diagnosis
Diagnosis mainly relies on medical history and clinical symptoms and signs, blood test often can not provide a valid basis, ultrasound, CT and other imaging tests can help the diagnosis of this disease, laparoscopy has a high diagnostic rate, but it should be used with caution, so as not to bring unnecessary damage.
Differential diagnosis
It needs to be differentiated from AIDS combined with inflammatory diseases of the gastrointestinal tract, such as cytomegalovirus colitis and acute appendicitis, etc. The latter can often be cured by non-surgical treatment, but AIDS combined with appendicitis requires surgical resection, so delayed treatment should be avoided.
Complications
Inadequate treatment may result in appendiceal perforation and thrombophlebitis.
Treatment
Once the diagnosis of AIDS combined with appendicitis is confirmed, early surgical removal of the appendix should be performed, and combined with highly effective antibiotic therapy, a better short-term survival can be achieved. Most patients have unexplained persistent fever (more than 1 week) after the operation, but there is no sign of sepsis, and the white blood cell count does not increase.