Management of biliary atresia in Nigeria: the ongoing challenge
P M Mshelbwala1, L Sabiu, C S Lukong
1Division of Paediatric Surgery, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria.
Insights
Biliary atresia in Nigerian infants has a poor outlook due to late diagnosis and referral. Early detection and referral by primary practitioners are crucial for improving outcomes in these children.
Area of Science:
- Pediatric Surgery
- Hepatology
- Neonatology
Background:
- Biliary atresia outcomes have improved in developed nations due to early detection and treatment.
- Limited data exists on the current prognosis for biliary atresia patients in sub-Saharan Africa.
Purpose of the Study:
- To evaluate the current outlook for infants with biliary atresia in Nigeria.
- To identify factors contributing to poor outcomes in this patient population.
Main Methods:
- Retrospective review of 14 pediatric patients diagnosed with biliary atresia.
- Data collected from Ahmadu Bello University Hospital, Zaria, between 1991 and 2004.
Main Results:
- Most patients (11/14) presented with advanced liver cirrhosis, precluding corrective surgery.
- Only three infants underwent Kasai's portoenterostomy; all experienced poor outcomes, including death.
- Diagnostic limitations and loss to follow-up (10/14) further complicated patient management.
Conclusions:
- Late presentation, delayed referrals, and diagnostic challenges result in a poor prognosis for biliary atresia in this region.
- Enhanced primary practitioner education for early detection and referral is essential to improve infant outcomes.
Background:
In developed countries, the outlook for patients with biliary atresia has improved remarkably owing to early referral, good diagnostic facilities and the availability of liver transplantation. In Nigeria and most of sub-Saharan Africa, there is little information on the current outlook for these children.
Methods:
A retrospective review of 14 patients with biliary atresia managed from 1991 to 2004 at Ahmadu Bello University Hospital, Zaria.
Results:
Six girls and eight boys presented at between 6 and 24 weeks of age (median 16). Seven presented to another hospital with persistent jaundice in the neonatal period. Eleven at presentation already had liver cirrhosis and deranged coagulation and could not have corrective surgery. Three patients aged 8, 10 and 16 weeks had Kasai's porto-enterostomy. Facilities for diagnosis were limited. Ten patients were lost to follow-up and their outcome is unknown. Of the three patients who had porto-enterostomy, one died at 2 years from gastro-enteritis, one from cholangitis after 8 weeks, and one did not recover from anaesthesia. One patient who had a laparotomy and liver biopsy died from peritonitis.
Conclusion:
Owing to late presentation, delayed referral and difficulties in diagnosis, the outlook for infants with biliary atresia in this environment is poor. A concerted effort to encourage primary practitioners to detect and refer these infants at an earlier age is critical to outcome.
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