Biliary atresia in Zaria, Nigeria: a review

The true incidence of biliary atresia in Nigeria is unknown owing partly to incomplete investigation of jaundice in neonates and infants. During 13 years in Zaria, the diagnosis was histologically confirmed in 36 infants and children aged 2-20 months at the time of presentation. Laparotomy was performed in 26 but a bilio-enteric anastomosis was feasible in only 4 and did not establish bile flow. Fifteen patients died, 19 were lost to follow-up and are presumed dead, 2 are alive with persistent jaundice. In contrast, hepatic portoenterostomy performed before the age of 60 days has provided effective bile drainage in many infants in Japan and elsewhere and survival into adulthood is now possible. It is concluded that improvement in surgical care will depend on earlier presentation of children, perhaps through neonatal check-up clinics. Prompt evaluation of conjugated hyperbilirubinaemia would lead to early laparotomy for the Kasai operation to be attempted in selected cases.