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 conjugation in the liver cells and bile entry into the duodenum via the ampulla. Early diagnosis is important to prevent secondary liver cirrhosis from prolonged cholestasis.

After due ethical considerations, information from patients with obstructive jaundice who presented into our service from December 2013 to April 2018 were analysed using SPSS version 23.

Twenty-five patients were managed for obstructive jaundice within the time period stated, with a mean age of 58±14years with a M:F ratio of 1:2. Cancer of the head of the pancreas accounted for 61% of the entire cause of OJ while chronic pancreatitis was the commonest benign cause in this series, accounting for 50% of all benign cases. Yellowness of the eyes and abdominal pain were the commonest presentation in 84% and 80% of the patients respectively. Overall 30-day post op mortality was 60% with ascending cholangitis being the cause in 78% of cases

Obstructive jaundice poses a big problem for the general surgeon as he needs to effectively manage the primary cause of the OJ along with the problems of cholestasis. OJ remains a huge burden in this setting and it is associated with a high morbidity and mortality. Even though 15 out of the 25 patients underwent surgery, none of the patients with malignant etiology had resection of their primary tumour as they all presented with unresectable disease. The 30-day mortality post laparotomy at 60% is about four times that obtained in the developed world. Less invasive methods of biliary drainage should be advocated to improve outcome of these patients. Surgery remains the best modality of treatment of OJ. The high rate of post laparotomy mortality suggests that an alternate means of biliary bypass in patients with advanced unresectable disease, other than routine laparotomy, should be encouraged.

Key Words: Obstructive Jaundice, Management, Nigeria, Pancreatic Cancer, Chronic Pancreatitis