Alarming Mortality of Biliary Atresia in Two Senegalese Tertiary Hospitals: A Plea For Early Diagnosis

Ibrahima  Bocar Wellé; Pape  Alassane Mbaye; Ndeye  Aby Ndoye; Faty  Balla Lo; Ndeye  Fatou Seck; Doudou  Gueye; Dior  Ndiaye; Florent  Tshibwid A Zeng; Aminata  Mbaye; Oumar  Ndour; Gabriel  Ngom

doi:10.19044/esj.2022.v18n11p51

Ibrahima Bocar Wellé Service of Pediatric Surgery, Albert Royer National Childen’s Hospital Center, Université Cheikh Anta Diop, Dakar, Senegal
Pape Alassane Mbaye Service of Pediatric Surgery, Albert Royer National Childen’s Hospital Center, Université Cheikh Anta Diop, Dakar, Senegal
Ndeye Aby Ndoye Service of Pediatric Surgery, Albert Royer National Childen’s Hospital Center, Université Cheikh Anta Diop, Dakar, Senegal
Faty Balla Lo Service of Pediatric Surgery, Pikine National Hospital Center, Université Cheikh Anta Diop, Dakar, Senegal
Ndeye Fatou Seck Service of Pediatric Surgery, Albert Royer National Childen’s Hospital Center, Université Cheikh Anta Diop, Dakar, Senegal
Doudou Gueye
Dior Ndiaye Service of Pediatric Surgery, Diamniadio Children’s Hospital, Dakar, Senegal
Florent Tshibwid A Zeng
Aminata Mbaye Service of Pediatric Surgery, Albert Royer National Childen’s Hospital Center, Université Cheikh Anta Diop, Dakar, Senegal
Oumar Ndour Service of Pediatric Surgery, Aristide Le Dantec University Teaching Hospital, Université Cheikh Anta Diop, Dakar, Senegal
Gabriel Ngom Service of Pediatric Surgery, Albert Royer National Childen’s Hospital Center, Université Cheikh Anta Diop, Dakar, Senegal

DOI: https://doi.org/10.19044/esj.2022.v18n11p51

Keywords: Biliary Atresia, Delayed Diagnosis, Mortality

Abstract

Background: The management of biliary atresia is challenging in low-income countries, with delayed diagnosis and its consequences. We aimed to report its epidemiological, diagnostic, therapeutic aspects and outcomes in Dakar, Senegal.

Methods: We conducted a 5-year retrospective review, which included 16 patients, admitted in the pediatric surgery services of Aristide Le Dantec University Teaching Hospital and Diamniadio Children's Hospital.

Results: The mean age at admission was 105.6 (1 - 420 days), with 10 girls. Cholestatic jaundice was found in all cases, discolored stools in 43.7%, dark urine and hepatomegaly in 31.2%. All patients had biological cholestasis and cytolysis syndromes. The ultrasound was performed in all patients with a sensitivity of 56.2%. The mean age at the time of surgery was 145 days (22 – 540 days). The surgical exploration was conducted in 10 cases and found type IV Biliary Atresia in 50%. The Kasai procedure was performed in 4 cases and liver biopsy in 9 cases. Mortality occurred in 75% (50% post-operatively and 25% pre-operatively). In two cases, the postoperative course was unremarkable with the success of the Kasai Procedure after a 42-months follow-up. Two patients were lost to follow-up.

Conclusion: Biliary atresia still has high mortality in our context. This is mainly due to delayed diagnosis, which is common in our environment. Multidisciplinary assessment of persistent neonatal jaundice is crucial to reduce biliary atresia-related mortality

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