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Category: Volume 06 Issue 07 July 2018
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Title: Presentation, Etiology and Management of Obstructive Jaundice: A Prospective Study

Authors: Nilesh P. Mangam, Dr Sanjay D. Dakhore, Rithesh M. Bodade, Asmita S. Dhurve, Amol P. Dhoran

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i7.36

Abstract

Introduction: Obstructive jaundice is caused by defective transport of conjugated bilirubin from hepatic cells to the second part of duodenum. It is not a diagnosis in itself and varied etiologies may be responsible for obstructive jaundice. It is important to diagnose the cause of obstructive jaundice because delay in diagnosis may cause irreversible pathological changes. The diagnosis of obstructive jaundice usually is done by biochemical tests, imaging and in some cases by histopathology. Management depends upon the etiology. Many cases of extra hepatic biliary obstruction are amenable to surgery if diagnosed at an appropriate time. We conducted this study to know etiology, clinical presentation and management outcome of the patients diagnosed to have obstructive jaundice.

Materials and Methods: This was a prospective study conducted in the department of surgery of a tertiary care medical college situated in an urban area. Patients above the age of 18 years who were admitted and diagnosed to have obstructive jaundice were included in this study depending upon a predefined inclusion and exclusion criteria. The diagnosis was confirmed by Imaging. Ultrasonography was done in all cases. Computed Tomography, MRCP, ERCP and biopsy were done in selected cases. Treatment outcome and complications were noted in all the cases. The data was analyzed using SSPE 16 software. P value less than 0.05 was taken as significant for statistical purposes.

Results: The study consisted of 106 patients of obstructive jaundice out of which male patients were 58 (54.71%) and female patients were 48(45.28%). The male to female ratio was 1.2: 1.the incidence of obstructive jaundice was highest in the age group of 51-60 years.the most common symptom was jaundice which was present in all 106 patients (100%). The other common symptoms were pain in abdomen (68.86%), loss of appetite (59.43%), loss of weight (57.54%) and itching (41.50%). Most common sign was icterus (100%) followed by abdominal tenderness (50.94%), itching marks (41.50%) and palpable gall bladder (39.62%). The most common finding on ultrasound as well as CT was found to be dilated common bile duct. Choledocholithiasis was found to be the most common benign cause of obstructive jaundice (32.07%) while most common malignancy causing obstructive jaundice was carcinoma head of pancreas (29.24%). Interventions included common bile duct exploration, stenting and cholecystojejunostomy. Surgical bypass and endoscopic stenting was done in 33 and 16 patients respectively. The most common post-operative complication in studied cases was found to be wound infection (5.66%) followed by cholangitis (3.77%) and septicemia (2.83%).

Conclusion: Obstructive jaundice is one of the common causes of surgically amenable jaundice. Its etiology is varied and diagnosis usually depends upon appropriate imaging. Proper diagnosis and treatment is necessary as delay in the diagnosis may cause irreversible pathological changes causing increased morbidity and mortality.

Keywords: Obstructive jaundice, Imaging, Surgical Interventions, Complications.

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Corresponding Author

Dr Sanjay D. Dakhore

Assistant Professor, Department of Surgery

Government Medical College and Hospital Nagpur, Maharashtra, India