[Acute peritoneal tuberculosis in HIV-infected patients. Study of 4 cases in Abidjan, Côte-d'Ivoire]. / Péritonite aiguë tuberculeuse au cours de l'infection par le VIh. Etude de 4 cas à Abidjan, Côte-d'Ivoire.

This paper presents 4 cases of histologically verified peritoneal tuberculosis in HIV-infected patients followed in a 18 month-period. The patients were admitted in emergency and were suspected of present acute appendiceal peritonitis. There were 3 females of 18, 22 and 27 years old, and a 41-year-old male. The main symptoms were acute abdominal pain (4 cases), fever superior to 38 degrees C (4 cases) and abdominal defence (4 cases). Laboratory findings were hyperleucocytosis with lymphocytic predominance, anemia and CD4+ rate variable from 250 to 460/mm3. They underwent emergency laparotomy which led to diagnosis of peritoneal tuberculosis by histopathological analysis of peritoneal biopsies. Two patients died from surgery at days 3rd and 10th. The 2 remaining patients were successfully treated by tuberculostatic tritherapy with rifampicin, isoniazid, and pirazinamid. Acute peritoneal tuberculosis in HIV-infected patients is not to be missed in our practice. It must be considered in differential diagnosis of acute abdomens.

Typhoid ileal perforation: surgical experience of 64 cases.

OBJECTIVE: Intestinal complications of typhoid fever are quite common in developing countries. In order to contribute to the improvement of the prognosis of typhoid ileal perforation, the authors report their own surgical experience PATIENTS AND METHODS: between May 95 and July 98, 64 patients, (31 men and 33 women), with an average age of 34 years (ranging from 5 to 63 years) underwent surgery for typhoid ileal perforation. The surgical techniques used were excision-suture (n = 31) and resection-ileostomy (n = 33). All the patients were operated under similar pre-, per- and postoperative care facilities. RESULTS: Postoperative complications were observed in 59 patients (88.1%). The mean hospital stay was 30 days (ranging from 8 to 52 days). The overall postoperative mortality was 34% (22/64), mainly due to digestive fistula in 11 cases (8 cases of anastomotic leak after excision-suture, 3 cases of bowel fistula after conservative resection-ileostomy) and to chronic peristomal ulceration in 9 cases, which led to progressive malnutrition, cachexy and death. CONCLUSION: The mortality and morbidity after surgical treatment of typhoid ileal perforation remains very high in developing countries. However some recommendations could improve the outcome: aggressive resuscitation by intravenous hydratation of 4 to 6 hours, associated with adequate antibiotherapy, the resection of the last 60 centimetres of the ileum, in cases of serious abdominal suppuration, and a large abdominal washout.