Surgical considerations in the management of the immunocompromised patient

We have attempted to give a broad overview of issues of importance to the surgeon that may arise in the management of the immunocompromised patient. These include airway obstruction, diffuse and focal pulmonary lesions, vascular access problems, gastrointestinal bleeding, perforation, obstruction, and soft tissue infections. Principles of perioperative management in this patient group are discussed in detail. Often they will require broad metabolic and hemodynamic support. The spectrum of pathology ranges from common problems found in the general patient population that present with only subtle clinical findings, making diagnosis difficult, to conditions unique to the patient with a deficient immune system. The importance of early consultation with the surgeon for the indications that have been described cannot be overemphasized. One should attempt to identify certain surgeons who have a particular interest in dealing with these complex problems. It is of the utmost importance for the surgeon to have the guidance of the primary physician with regard to aggressiveness of therapy. This decision must take into account the basic underlying disorder as well as the wishes of the patient and family. Many of these patients can be salvaged despite the seemingly endless problems that may arise along the way.