Aetiology and Challenges of Managing Obstructive Jaundice in a Resource‑limited Setting in South Western Nigeria

Abstract

Background: Obstructive jaundice is a common clinical condition with a varying diverse spectrum of aetiology from region to region and its management is often associated with challenges. Aims: To highlight the spectrum of aetiology, challenges, and limitations in the  management of obstructive jaundice in a resource‑limited setting.

Patients, Materials and Methods: Prospective descriptive study over a period of seven years in two teaching hospitals in Nigeria.  Patients with a diagnosis of obstructive jaundice between April 2015 and March 2022 were consecutively enrolled into the study. Relevant  data were obtained through a pretested paper pro forma.

Results: Eighty-four patients were studied. The mean age of the patients was  54.8 ± 2.1 with male to female ratio of 1.1: 1. Malignant cases were responsible for 84.5% of cases. The mean duration of the disease was  119.6 ± 13.7. All patients had an abdominal ultrasound scan done. Only 42.4% of patients could afford computed axial tomography (CAT),  and other minimally invasive investigations were not available. The mean bilirubin level shows a statistically significant difference  between benign and malignant cases (301 ± 9.8 vs. 398 ± 11.1; P < 0.001). Sixty‑five (80.2%) patients were operated upon. Fifty‑five (84.6)  patients’ surgeries were delayed. None of the patients operated upon had intraoperative cholangiography due to lack of facility and no  laparoscopic procedure was done. 

Conclusion: Obstructive Jaundice is a common surgical condition in our environment. The majority of  cases were malignant in origin and delayed presentation and lack of modern diagnostic and therapeutic facilities were responsible for  poor outcomes.