OBSTRUCTIVE JAUNDICE: ETIOLOGY AND PATTERN OF PRESENTATION

Abstract

Surgical jaundice mainly occurs due to obstruction in any duct from the liver to the gall bladder and then the small intestine. It can be divided into intra-hepatic or extra-hepatic causes. Biliary stones, iatrogenic or ischemic biliary stricture, pseudo-pancreatic cysts, carcinoma of the head of the pancreas, and periampullary carcinomas are common pathologies of obstructive jaundice. Common bile duct stones account for 10-15% of biliary stone disease and are the most common cause of obstructive jaundice. Obstructive jaundice presents with a wide range of associated features. Ultrasonography, MRCP, and ERCP are the primary diagnostic tools for diagnosing and managing obstructive jaundice, in addition to blood tests. This study aims to determine the pattern of presentation and causes of obstructive jaundice. This observational, retrospective study was conducted in general surgery and surgical oncology unit 2 of Sheikh Zayed Hospital, Lahore. The study lasted from January 2022 to April 2023. A non-probability convenience sampling technique was used. A total of 55 patients with obstructive jaundice were presented in the study area in a defined period, which included 17 (30.90%) males and 38 (69.09%) females. The mean age was 49 years, with age ranges from 28 years to 80 years. 13 (23.66%) patients were found to have malignant disease, whereas 42 (76.33%) patients presented with benign disease. The most common malignant cause of obstructive jaundice was carcinoma head of the pancreas (10.90%), whereas the least common causes were cholangiocarcinoma (1.82%), carcinoma gall bladder (1.82%) and malignant biliary stricture (1.82%). The most common benign cause and overall most common cause of obstructive jaundice was choledocholithiasis (32.73%), followed by referred biliary injuries (18.18%). The most common clinical feature presented in benign causes of obstructive jaundice was jaundice (100%), followed by itching (71.4%) and abdominal pain (64.28%). The most common clinical feature in malignant causes of obstructive jaundice was jaundice (100%), followed by loss of appetite (84.61%) and weight loss (84.61%). Female was the most common gender presented with obstructive jaundice. The most common benign cause of obstructive jaundice was Choledocholithiasis, while the most malignant cause was carcinoma head of the pancreas.