Yousaf Jan, Ihsan Ulhaq, Waqas, Ahmad Din.
The Etiological Spectrum of Obstructive Jaundice and Treatment Outcome.
Ophthalmol Update Jan ;12(4):331-5.

Background: Obstructive jaundice poses diagnostic and therapeutic challenges to general surgeons practicing in resourcelimited countries. Objective: To evaluate the causes, presentation and treatment of obstructive Jaundice cases. Material and Methods: This prospective, descriptive study was carried out in Hayatabad Medical Complex Peshawar through one and a half years period from January 2009 to June 2010 on 115 patients after taking permission from local ethical and research committee. All patients with a clinical diagnosis of obstructive jaundice were, after informed consent for the study, consecutively enrolled into the study and were thoroughly investigated and their cause established. After appropriate preparations surgery was carried out; the procedure depending upon the nature of the lesion. Intra and post-operative complications, and the outcome of the patient were noted and the whole data analysed. Results: This study comprises of 115 cases of obstructive Jaundice.The mean age was 41.59 years±11.38SD with range of 19-70 years. Forty eight (41.7%)were males and 67 (58.3%) females. All patients had jaundice, while abdominal pain, weight loss, nausea and vomiting, pruritus, fever with chills and abdominal mass were other presenting complaints (Table 1). Amongst these,62 (53.9%) patients had jaundice due to common bile duct stones, 44 (38.2%) had malignancy of the biliary tract, biliary strictures in 6 (5.2%) cases, pseudopancreatic cyst in 2 (1.73%) cases and worms in common bile duct in one (0.86%) case respectively (Table 2). In the biliary malignant group,29 (25.2%) patients had carcinoma head of the pancreas, 4(3.5%) had cholangio-carcinoma, 6 (5.2%) had carcinoma gall bladder,3(2.6%) patients with malignant nodes at the portahepatis and 2 (1.73%) had secondary metastasis in liver (Table 2). All patients with stones in the CBD were treated by cholecystectomy, ERCP and choledocholithotomy. Conclusion: Obstructive Jaundice is commonly caused by gall stones, pancreatic and other biliary tumours in our set-up. Early diagnosis of the cause of obstruction is very important especially in malignant cases, as resection is only possible at that stage.

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