Long survival ( 21 years) after portoenterostomy for biliary atresia: A case report and review of complications

Long term survival for decades after portoenterostomy (Kasai procedure) for biliary atresia is rare and the association of portoenterostomy with liver cirrhosis is well known. Not much attention was given in the evaluation of the imaging features of cirrhosis caused by portoenterostomy as received by other known usual causes of cirrhosis. We presented a case of a Nigerian with confirmed biliary atresia at birth, that suvived portoenterostomy performed at two months of age for 21years. The cirrhotic presentation at imaging was that of prominent volume redistribution with less parenchymal changes in the liver. The long term survival and the type of cirrhotic presentation on imaging in this case is worthy of note for the record

PRESENTATION OF PRIMARY MEDIASTINAL MASSES IN IBADAN

ABSTRACTObjective: To determine clinical features, anatomic location and histological types of primarymediastinal masses diagnosed and treated in a black African population.Design: A retrospective study of clinical data collected from patients case notes, thecardiothoracic unit’s and pathology records between June 1975 and May 1999.Setting: University College Hospital, Ibadan, Nigeria which hosts a major cancer center inthe West African sub-region, and serves community clinics.Patients: All patients with primary mediastinal masses referred for evaluation and treatment.Main outcome measures: Excluded metastatic, oesophageal and vascular- lesions. All patientshad radiological evalulation and tissue biopsies. The anatomic subdivision of the mediastinuminto anterosuperior, middle and posterior section was used.Results: One hundred and five consecutive patients were evaluated and treated. The meanage was 34.0 ± 20.4 years. There were 75 males and 30 females. Eighty one (77.1%) weresymptomatic, 24 (22.9%) were asymptomatic. Thirty seven (45.7%) of the symptomaticpatients had malignant disease while 44 (54.3%) had benign disease. Forty five patients(43%) and 60 patients (57%) had malignant and benign diseases respectively. Incidence ofsymptoms, was 82.2% for malignant and 73.3% for benign diseases. This difference inincidences is statistically insignificant (p=0.283). Majority of asymptomatic patients (70.8%)had benign disease while 29.2% of patients with malignancy were asymptomatic. Thisdifference in incidence was statistically significant (p=0.0039). The frequency of mediastinalmasses were anterosuperior, in 67 patients (63.8%), posterior mediastinal, 24 patients(22.9%) and middle mediastinal in 14 patients (13.3%). Lymphoma 23 (21.9%), thymusglands tumours 19 (18.1%) and endocrine tumours (goiters) 18 (17.1%) were the commonesttypes of primary mediastinal masses treated.Conclusion: Majority of our patients with mediastinal masses (whether benign or malignant)are symptomatic and the absence of symptoms is more associated with benign disease.Majority of lesions are situated in the anterosuperior mediastinum. Lymphoma is the mostfrequent primary mediastinal mass