Abdominal CT findings in HIV-infected patients presenting with acute abdomen

Abstract

INTRODUCTION: Clinicians have often been faced with the dilemma of whether to manage HIV-positive patients presenting with an acute abdomen surgically or conservatively. Since poorer outcomes have been associated with surgery, CT scan has been an important tool in clinical decision-making. AIM: The aim of the study was to evaluate the abdominal CT findings of HIV-positive patients that presented with an acute abdomen, with specific interest in abdominal TB. METHOD: A retrospective and quantitative study was conducted on HIV-positive adults (50) referred for diagnosis of "acute abdomen" RESULTS: Fifty percent the patients had a radiological emergency diagnosis, of which only 18% needed surgery, and 44% had a TB related diagnosis on discharge. CT scan had a sensitivity of 73% and a specificity of 64% (PPV 36%, NPV 89%) in the diagnosis of abdominal TB when compared to laboratory diagnostic tests. When CT scan was compared to a "probable diagnosis" of TB the sensitivity and specificity, increased to 81% and 83% respectively (PPV 77%, NPV 86%).The inter-reader agreement ranged from moderate to almost perfect. CONCLUSIONS: CT scan was found to be a very useful tool in the management of HIVpositive patients who presented with an acute abdomen. Not only did CT scan identify TB of the abdomen, when surgical management could have been avoided, it frequently excluded TB as a cause and assisted in the further surgical management of the patient. The HIV-positive patient with acute abdomen should receive a contrasted CT scan as part of their work-up not only to diagnose surgical emergencies but also to avoid unnecessary surgery.