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

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.