A retrospective study of billiary atresia as seen and managed in KNH over a seventeen year period 1985-2001.

SUMMARY

 

A retrospective study of biliary atresia as seen and managed in Kenyatta National Hospital was carried out.  It covered an eleven (11) year period between 1991 to 2001.  The original interval period of seventeen years between 1985 to 2001 was reversed to 11 years.  The period between 1985 to 1990 was excluded since no files in that period could be traced.

 

Biliary atresia is the commonest cause of infantile cholestatic jaundice and is only amenable to surgery.

 

In the study period, 44 cases were reviewed giving an average of 4 cases per year being seen in KNH.  All were of black race.  There was a female preponderance of 1:0.69.

 

Biliary atresia constituted 1.5% of all neonatal jaundice seen in KNH in the study period.  Thirty-seven (85%) of the patients seen in KNH were referrals with only 7 (15%) being seen primarily in KNH.

 

Average age at referral was 110 days and outside the age bracket when jaundice clearance is expected after surgery.  Only 45% of patients were seen within 90 days of age.

 

Confirmatory test done in KNH included ultrasound, liver biopsy and operative cholangiography.

 

Eleven (25%) out of the 44 cases seen had operation to relieve extrahepatic biliary obstruction.  The mean age at operation was 90 days with a range of 51 to 110 days.  There was a strong association between the age at operation and jaundice clearance, hepatic decompensation and occurrence of cholangitis.

 

The morphological type had strong association with jaundice clearance.

 

No mortality was recorded in the group that had operation.  Consequently, survival outcome could not be established.  The mean duration of follow up was 7 months.

Death in those who did not have any form of operation to relieve extrahepatic biliary obstruction occurred at an average age of 9.7 months.

 

The duration of follow up in those who did not have operation and were still alive at last follow up was 6 months.

 

Overall majority of the patients were seen at an advanced age when surgery would not be beneficial.

 

Valuable time was lost before patients were referred to Paediatric surgeon.  The diagnosis of biliary atresia requires a high index of suspicion and in KNH simple and fast diagnostic methods are not performed due to lack of equipment and materials.  This necessitated the use of invasive procedures such as percutaneous biopsy and exploratory laporatomy.  There is a need for KNH to invest in these diagnostic tools to expedite early diagnosis and surgery.

Clinicians need a constant reminder of the ever presence of biliary atresia as one in a spectrum neonatal cholestasis.  This should include standard management of the condition, which will lead to early diagnosis, surgery and follow up.  

 

 The management of biliary atresia has been improving with time and record keeping of patients managed in KNH ought to be updated so that frequent auditing can be done with a view of standardizing the management of this condition.