{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2024,2,14]],"date-time":"2024-02-14T13:24:59Z","timestamp":1707917099172},"reference-count":26,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2007,3,30]],"date-time":"2007-03-30T00:00:00Z","timestamp":1175212800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2007,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Human immunodeficiency virus\/acquired immunodeficiency syndrome (HIV\/AIDS) has resulted in a resurgence of abdominal tuberculosis in South Africa, and these patients often present to general surgeons. We describe a single\u2010hospital experience in a region of high HIV prevalence.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A prospective database of all patients with suspected abdominal tuberculosis was maintained from January 2003 until July 2005.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There were 67 patients (20\u00a0men, 47 women) with an average age of 32 years (range 27\u201361 years). The erythrocyte sedimentation rate was universally elevated (105 \u00b1 23). Altogether, 23 patients were HIV\u2010positive and 7 were HIV\u2010negative. The status was unknown in the remainder. Chest radiographs demonstrated an abnormality in 17 patients (22%). Abdominal ultrasonography was performed in 59 patients and computed tomography in 12. Twelve laparotomies were performed, seven as emergencies. None in the elective laparotomy group died, whereas the mortality rate in the emergency group was 60%. Laparoscopy was insufficient for a variety of reasons. Two patients underwent appendectomy and two excision of a perianal fistula. Two patients underwent biopsy of a palpable subcutaneous node, which confirmed the diagnosis in both cases. A definitive diagnosis was achieved in all 12 patients subjected to laparotomy and at colonoscopic biopsy in 2, lymph node biopsy in 2, appendectomy in 2, perianal fistulectomy in 2, and percutaneous drainage in 2. In the remaining 47 patients the diagnosis was made on the basis of the clinical presentation and radiologic imaging. The patients were commenced on antituberculous therapy. The in\u2010hospital mortality in this group was 10%. Therapy was continued at a centralized tuberculosis facility independent of the hospital. Surgical follow\u2010up was poor, with only five (7%) patients completing the 6\u2010month review at a surgical clinic.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>A resurgence in tuberculosis during the HIV era produces a new spectrum of presentations for the surgeon. Emergency surgery is associated with high mortality. Bacterial and histologic evidence of infection are difficult to obtain, and indirect clinical and imaging evidence are used to commence a trial of therapy. A short\u2010term clinical response is regarded as proof of disease. Lack of follow\u2010up means that the efficacy of this strategy is unproven. Health policy changes are needed to enable appropriate surgical follow\u2010up to determine the most effective management algorithm.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-007-0402-8","type":"journal-article","created":{"date-parts":[[2007,4,10]],"date-time":"2007-04-10T11:29:24Z","timestamp":1176204564000},"page":"1088-1097","source":"Crossref","is-referenced-by-count":16,"title":["A Single Surgical Unit\u2019s Experience with Abdominal Tuberculosis in the HIV\/AIDS Era"],"prefix":"10.1002","volume":"31","author":[{"given":"D.L.","family":"Clarke","sequence":"first","affiliation":[{"name":"Department of General Surgery Nelson R Mandela School of Medicine, University of Kwa\u2010Zulu Natal Private Bag 7 4013 Congella Durban South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S.R.","family":"Thomson","sequence":"additional","affiliation":[{"name":"Department of General Surgery Nelson R Mandela School of Medicine, University of Kwa\u2010Zulu Natal Private Bag 7 4013 Congella Durban South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"T.","family":"Bissetty","sequence":"additional","affiliation":[{"name":"Department of General Surgery Nelson R Mandela School of Medicine, University of Kwa\u2010Zulu Natal Private Bag 7 4013 Congella Durban South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"T.E.","family":"Madiba","sequence":"additional","affiliation":[{"name":"Department of General Surgery Nelson R Mandela School of Medicine, University of Kwa\u2010Zulu Natal Private Bag 7 4013 Congella Durban South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"I.","family":"Buccimazza","sequence":"additional","affiliation":[{"name":"Department of General Surgery Nelson R Mandela School of Medicine, University of Kwa\u2010Zulu Natal Private Bag 7 4013 Congella Durban South 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