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Clinico-pathological Evaluation and Outcomes of Emergency Right Hemicolectomies in the HIV Era

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Abstract

Emergency right hemicolectomies (RH) are attended by high morbidity and mortality. A primary ileocolic anastomosis (PA) or stoma may be performed, depending upon clinical risk factors. In HIV/AIDS patients, multiple pathologies involve the ileo-caecal area, and may necessitate a RH. To provide a clinico-pathological evaluation and outcome analysis of emergency RH. A retrospective chart analysis of 55 patients undergoing an emergency RH in two regional referral centres in KwaZulu-Natal, from January 2013 to December 2018, was undertaken. A total of 55 patients, median age 35 (range 12–83 years), underwent emergency RH. Seventeen patients were HIV-positive (30.9%) and 36 HIV-negative (65.5%), while 2 were not tested. A RH with PA was more commonly performed (61.8%). There was a higher rate of metabolic acidosis (p = 0.0046) and inotropic support (p = 0.001) in the RH and ileostomy cohort. The mortality rate was significantly higher in the RH and ileostomy cohort (42.9% vs 14.7%), p = 0.0275. There was a significantly higher rate of RH and ileostomy done in the HIV-positive cohort than in the HIV-negative cohort (58.8% vs 27.7%), p = 0.03. Ileo-caecal tuberculosis was more common in HIV-positive patients (35.3% vs 2.8%), p = 0.003. Overall, complicated appendicitis was the most common indication for RH (38.2%). Emergency RH with ileostomy is performed more often in the physiologically unstable patient and, hence, has a high mortality rate. Ileo-caecal TB is more common in HIV-positive patients leading to a higher ileostomy rate. Complicated appendicitis was the most common indication for emergency RH.

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Authors and Affiliations

  1. Supernumerary surgery registrar, University of KwaZulu-Natal, 238 Mazisi Kunene Rd, Glenwood, Durban, 4041, South Africa

    Girish Bundhoo

  2. Addington Hospital, University of KwaZulu Natal, 238 Mazisi Kunene Rd, Glenwood, Durban, 4041, South Africa

    Shakeel Kader

  3. Surgery Medical officer Grade 2, Madadeni Hospital, Madadeni Road, Madadeni, Newcastle, 2951, South Africa

    Che Gift Manneh

  4. Head Clinical Unit : Surgery, Madadeni Hospital, University of KwaZulu-Natal, 238 Mazisi Kunene Rd, Glenwood, Durban, 4041, South Africa

    Shalen Cheddie

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  1. Girish Bundhoo
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  2. Shakeel Kader
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  3. Che Gift Manneh
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  4. Shalen Cheddie
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Correspondence to Shalen Cheddie.

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Ethical approval to conduct the study was obtained from the Biomedical Research Ethics Committee of the University of KwaZulu - Natal.

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The authors declare that they have no competing interests.

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Bundhoo, G., Kader, S., Manneh, C.G. et al. Clinico-pathological Evaluation and Outcomes of Emergency Right Hemicolectomies in the HIV Era. Indian J Surg 82, 604–609 (2020). https://doi.org/10.1007/s12262-020-02079-0

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  • DOI: https://doi.org/10.1007/s12262-020-02079-0

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