Management Of Obstructive Jaundice: Experience In A North Central Nigerian Hospital.

Abstract

Obstructive jaundice (OJ) occurs as a result of blockage in the pathway between the site of bile Obstructive jaundice is defined as a condition conjugation in the liver cells and bile entry into the occurring due to a block in the pathway between the site duodenum via the ampulla. Early diagnosis is of conjugation of bile in liver cells and the entry of bile important to prevent secondary liver cirrhosis from into the duodenum through the ampulla.1 The need for prolonged cholestasis. early diagnosis and intervention is key to preventing After due ethical considerations, information permanent damage to the liver (secondary liver from patients with obstructive jaundice who presented cirrhosis). Obstructive jaundice can be caused by into our service from December 2013 to April 2018 different pathologies which may be intrahepatic or were analysed using SPSS version 23. extra hepatic, benign or malignant and varies from Twenty-five patients were managed for centre to centre.2,3 obstructive jaundice within the time period stated, with Obstructive jaundice is not a definitive a mean age of 58±14years with a M:F ratio of 1:2. diagnosis on its own and the onus lies on the physician Cancer of the head of the pancreas accounted for 61% to determine the primary cause using extensive clinical of the entire cause of OJ while chronic pancreatitis was evaluation as well as investigative modalities. the commonest benign cause in this series, accounting Biochemical and radiologic investigations are key for 50% of all benign cases. Yellowness of the eyes and adjuncts to clinical review to assist in making a abdominal pain were the commonest presentation in diagnosis, to assess the stage and extent of the disease 84% and 80% of the patients respectively. Overall 30- and to see fitness for intervention. The abdominal day post op mortality was 60% with ascending ultrasound is a valuable tool in the initial evaluation of cholangitis being the cause in 78% of cases patients with obstructive jaundice. It is widely Obstructive jaundice poses a big problem for available and affordable in our setting, however, it is the general surgeon as he needs to effectively manage usually inadequate in estimating the extent of disease the primary cause of the OJ along with the problems of and also in predicting resectability. The lack of cholestasis. OJ remains a huge burden in this setting sophisticated diagnostic modalities such as ERCP, and it is associated with a high morbidity and mortality. MRCP and helical CT, as well as lack of support Even though 15 out of the 25 patients underwent systems and technical expertise means that patients surgery, none of the patients with malignant etiology have outcomes that are even poor for a disease with had resection of their primary tumour as they all such high morbidity and mortality. Surgery in presented with unresectable disease. The 30-day jaundiced patients is associated an increased rate of mortality post laparotomy at 60% is about four times wound problems, sepsis from cholangitis, bleeding that obtained in the developed world. Less invasive abnormalities, hypotension, gastrointestinal bleeding, methods of biliary drainage should be advocated to anastomotic leakage, abdominal abscess and liver or improve outcome of these patients. Surgery remains renal failure.4-6 This study seeks to show an the best modality of treatment of OJ. The high rate of understanding of the characteristics, pattern of post laparotomy mortality suggests that an alternate presentation, management and treatment outcomes of means of biliary bypass in patients with advanced patients with obstructive jaundice at the University of unresectable disease, other than routine laparotomy, Ilorin Teaching hospital. should be encouraged.

Obstructive jaundice (OJ) occurs as a result of Introduction blockage in the pathway between the site of bile Obstructive jaundice is defined as a condition conjugation in the liver cells and bile entry into the occurring due to a block in the pathway between the site duodenum via the ampulla. Early diagnosis is of conjugation of bile in liver cells and the entry of bile important to prevent secondary liver cirrhosis from into the duodenum through the ampulla.1 The need for prolonged cholestasis. early diagnosis and intervention is key to preventing After due ethical considerations, information permanent damage to the liver (secondary liver from patients with obstructive jaundice who presented cirrhosis). Obstructive jaundice can be caused by into our service from December 2013 to April 2018 different pathologies which may be intrahepatic or were analysed using SPSS version 23. extra hepatic, benign or malignant and varies from Twenty-five patients were managed for centre to centre.2,3 obstructive jaundice within the time period stated, with Obstructive jaundice is not a definitive a mean age of 58±14years with a M:F ratio of 1:2. diagnosis on its own and the onus lies on the physician Cancer of the head of the pancreas accounted for 61% to determine the primary cause using extensive clinical of the entire cause of OJ while chronic pancreatitis was evaluation as well as investigative modalities. the commonest benign cause in this series, accounting Biochemical and radiologic investigations are key for 50% of all benign cases. Yellowness of the eyes and adjuncts to clinical review to assist in making a abdominal pain were the commonest presentation in diagnosis, to assess the stage and extent of the disease 84% and 80% of the patients respectively. Overall 30- and to see fitness for intervention. The abdominal day post op mortality was 60% with ascending ultrasound is a valuable tool in the initial evaluation of cholangitis being the cause in 78% of cases patients with obstructive jaundice. It is widely Obstructive jaundice poses a big problem for available and affordable in our setting, however, it is the general surgeon as he needs to effectively manage usually inadequate in estimating the extent of disease the primary cause of the OJ along with the problems of and also in predicting resectability. The lack of cholestasis. OJ remains a huge burden in this setting sophisticated diagnostic modalities such as ERCP, and it is associated with a high morbidity and mortality. MRCP and helical CT, as well as lack of support Even though 15 out of the 25 patients underwent systems and technical expertise means that patients surgery, none of the patients with malignant etiology have outcomes that are even poor for a disease with had resection of their primary tumour as they all such high morbidity and mortality. Surgery in presented with unresectable disease. The 30-day jaundiced patients is associated an increased rate of mortality post laparotomy at 60% is about four times wound problems, sepsis from cholangitis, bleeding that obtained in the developed world. Less invasive abnormalities, hypotension, gastrointestinal bleeding, methods of biliary drainage should be advocated to anastomotic leakage, abdominal abscess and liver or improve outcome of these patients. Surgery remains renal failure.4-6 This study seeks to show an the best modality of treatment of OJ. The high rate of understanding of the characteristics, pattern of post laparotomy mortality suggests that an alternate presentation, management and treatment outcomes of means of biliary bypass in patients with advanced patients with obstructive jaundice at the University of unresectable disease, other than routine laparotomy, Ilorin Teaching hospital. should be encouraged.