n South African Journal of Surgery - Primary tuberculosis of the gallbladder in an HIV-positive patient : letters to the editor
|Article Title||Primary tuberculosis of the gallbladder in an HIV-positive patient : letters to the editor|
|© Publisher:||Medpharm Publications|
|Journal||South African Journal of Surgery|
|Author||S. Sobnach, G. D. Van Der Linde, D. Kahn and A. Bhyat|
|Publication Date||Aug 2010|
To the Editor : A 37-year-old woman with untreated AIDS (CD4 count 14 cells//µl) presented with a history of haematemesis. She was anicteric, pyrexial and pale and had no peritonitism. The haemoglobin concentration was 6.1 g/dl, the white cell count 7.3x109/l and the platelet count 107x109/l. Gastroscopy showed two old pre-pyloric ulcers and a perforated ulcer in the first part of the duodenum. Laparotomy revealed a perforated ulcer in the posterior wall of the first part of the duodenum, a gangrenous gallbladder and a perforated necrotic common bile duct with a purulent bilious leak. There was no evidence of abdominal tuberculosis. The ulcer was managed with pyloroplasty and omental patch. A cholecystectomy was performed, with a Roux-en-Y hepatico-jejunostomy and entero-enterostomy. Helicobacter pylori eradication therapy and anti-tuberculosis treatment were initiated after histological confirmation of tuberculosis. The patient could not be weaned from the ventilator, her CD4 count dropped to 2 cells/µl, and she died of multi-organ failure 16 days later.
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