The presentation, operative management and jinal diagnosis were reviewed in 28 patients with AIDS (27 men and one woman) who underwent emergency laparotom-v. On clinical and radiological examination, six patients showed features of toxic megacolon, five patients had small bowel obstruction, six patients had localized peritonitis and three had perforated viscus with generalized peritonitis. The most common disease processes were acute colitis in seven patients (associated with cytomegalovirus ( C M V ) infection in six), intraabdominal lymphoma in five patients, acute appendicitis in jive patients (associated with C M V infection in two), and atypical mycobacterial ( M A I ) infection in four patients. Two perioperative deaths occurred: one in a patient with acute pancreatitis and a second with generalized peritonitis. Later deaths were due to progression of AIDS, and patient survival at 1 month, 3 months and 6 months was 89 per cent, 64per cent and 48per cent, respectively. Lower operative mortality than in previously reported series may be due to earlier intervention in C M V toxic megacolon. Surgery, however, conferred less benejit in patients with acute abdominal pain from M A I infection or lymphoma. With careful patient selection, emergency laparotomy may achieve worthwhile palliation in patients with AIDS.
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