Evaluation of the management of obstructive jaundice in Diwaniyia Teaching Hospital

Abstract

Background:
Obstructive Jaundice is a common surgical problem with variable causes ranging from benign causes like choledocholithiasis to malignant causes like carcinoma of head of pancrease,its clinical features vary according to its causes and the treatment vary from curative to palliative procedures. Many factors may affect the morbidity and mortality like the age of patients, depending etiology and the presence of associated comorbid diseases.
Aim of the study
To evaluate the management of obstructive jaundice in patient admitted to Al-Diwanyia Teaching Hospital.
Patients and Methods:
Prospective study was done in Al-Diwanyia Teaching Hospital between January 2011 and December 2014. 90 patients presented with obstructive jaundice admitted in AL-Dewanyia Teaching Hospital were included in this study. Data were collected regarding to the presenting clinical features, the diagnostic techniques, operative procedures and the causes of hospital mortality and morbidity and were analyzed so that a complete picture of these details can be assessed for obstructive jaundice in Al-Diwanyia teaching hospital.
Result
A total of 90 patients were studied. Female out numbered male by ratio of 1.5: 1. The majority of cases found in the age group 50-59 years. Most common etiology was choledocholithiasis.
Most patients with obstructive jaundice presented with jaundice and upper abdominal pain. The most frequent applied investigation was the liver function test which was done to all patients. Imaging techniques were applied variably with the U\S was the most applied while MRCP was the next; however, the accuracy was higher with the latter technique Intervention depends on the main etiology: for the choledocholithiasis, most common intervention was ERCP, for CA head of pancreas the most common operation done was by pass procedure and for complicated hepato biliary hydatid disease the CBD exploration with T-tube was the common.
The post-operative morbidity was 13.33% mostly due to respiratory complications, while mortality was 3.33 %
mostly due to sepsis .
Conclusion:
Most common cause of obstructive jaundice in patients referred to AlDiwanyia teaching hospital was choledocholithiasis and biliary stricture comes second.
U/S and MRCP are the most common applied imaging techniques in diagnosis of obstructive jaundice. The threshold for their application was high.
The most common applied intervention to treat obstructive jaundice was the therapeutic ERCP, while the least applied intervention was open surgical procedures