Portal hypertension: Aetiology and management at Kenyatta National Hospital, Nairobi, Kenya.

Abstract

One hundred and ninety three patients with portal hypertension were studied at the Kenyatta National Hospital during the period June 1976 to June 1986. There were 130 males and 63 females, aged between one year and sixty years, the average age being 26 years.

The commonest presenting features Were haematemesis, occuring in 154 (80%) cases, abdominal swelling, in 83 (43%) cases. Splenomegally occuring in 180 (93%) cases, hepatomegally 79 (41%), and ascites 76 (39%) were the commonest clinical signs.

On the basis mainly of the liver function tests, stool examination, rectal snip, liver biopsy and splenic venogram the various aetiological groups were identified. Schistosomiasis was the major cause of portal hypertension accounting for 93 (48%) cases, followed by liver cirrhosis, 40 (21%). Portal vein thrombosis was noted in 18 (9%)

of the patients. In 42 (22%) patients the cause of portal hypertension was not established.

93 (48%) of the patients studied were from the Kamba tribe and 49 (26%) were from the Kikuyu tribe, representing 74% of all the patients studied, largely because of their

geographical closeness to the Kenyatta National Hospital.

22 (11%)

15 (8%)

of the patients were from the Luo tribe, while were from the Luhyia tribe. It is noteworthy that

of the 93 patients from the Kamba tribe 56

(60%) of them

had schistosomiasis. This correlates well with the high incidence of portal hypertension and schistosomiasis seen in this tribe. It is also of interest that of the 22 patients studied from the Luo tribe 14 (60%) of them

had schistosomiasis.

146 patients were treated medically, and 47 were treated surgically. The surgical means of treatment included splenectomy alone, stapling of oesophageal varices, mesocaval shunt, portacaval shunt, and splenorenal shunt. The poorest results were obtained with stapling of oesophageal varices. All the three patients who had

this procedure died from recurrent haematemesis. Of the

three shunts, the splenorenal shunt appeared to have the least complications.