Percutaneous Transhepatic Biliary Drainage for Decompressive Purposes in Biliary Obstruction in Somalia: Single Interventional Radiology Facility Center in Somalia

Case Presentation: Percutaneous transhepatic biliary drainage for decompressive purposes in biliary obstruction in Somalia. Single interventional radiology facility center in Somalia.

Purpose: Interventional radiology (IR) provides a good alternative for patients with obstructive hepatobiliary disease (malignant and nonmalignant etiologies). Obstructive jaundice is common in our hospital since it is the only referral and tertiary hospital in Somalia. Prior to the opening of Mogadishu Somali Turkey Training and Research Hospital, which is the only interventional radiology facility center In Somalia (available in 16 slices Siemens CT, 1.5 tesla Siemens, Aplio 500 3 Ultrasound machines and one Mindray and GE Optima Angio) percutaneous biliary procedures were unavailable in Somalia before 2014, everything is done surgically. Many patients went abroad for simple procedures like PTC which was very expensive and time-consuming, while some patients got into a coma and died. IR has provided new ways of improving their quality of life. Here we demonstrate how minimally invasive therapies for obstructive jaundice were incorporated as a new treatment option in Somalia.

Materials and Methods: Between January 2023 and December 2023, all patients presenting to the Mogadishu Somali Turkey Training and Research Hospital with symptomatic obstructive jaundice were attended. Procedures were performed by IR-trained Somali and Turkish radiologists together with radiology residents. Patients were assessed for Preprocedural evaluation and provided procedural information regarding their symptoms and bilirubin levels. Postprocedural evaluation and follow-up data were done.

Results: A total of 25 percutaneous biliary drainage procedures were performed for this period of time. All patients were done external drainages, external-internal drainage procedure was not performed due to insufficient experience and lack of drainage catheters, Minor complications occurred in 5 cases out of 25 cases (according to SIR AE Classification) 20/25 procedures were technically successful,3 patient underwent subsequent catheter removal, one of whom required a repeat drainage due to tumor overgrowth 4 months later. 2 patients died within 2 months after drain placement due to worsening their clinical condition. None of the patients went on to receive chemotherapy-radiotherapy or surgical intervention Since Chemotherapy and Radiotherapy (Oncology center) are not available in Somalia. All patients reported subjective improvement in jaundice and generalized pruritus. Mean total bilirubin decreased significantly (120 to 60.5 µmol/L) 2 weeks postprocedures.

Conclusion: In low-resource countries like Somalia, IR significantly improves the quality of life for individuals suffering from obstructive jaundice. It is expected that this initiatory experience can be used to further improve education and collaboration with other services such as awareness of local clinicians about the IR service, to provide an increase and earlier access to hepatobiliary interventions with the ultimate goal to improve patient comfort and survival patients. We assess the effectiveness and better alternative to surgery retrospectively.

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Artikel online veröffentlicht:
02. April 2024