Etiological spectrum and treatment outcome of Obstructive jaundice at a University teaching Hospital in northwestern Tanzania: A diagnostic and therapeutic challenges

Abstract

BackgroundObstructive jaundice poses diagnostic and therapeutic challenges to general surgeons practicing in resource-limited countries. This study was undertaken to highlight the etiological spectrum, treatment outcome of obstructive jaundice in our setting and to identify prognostic factors for morbidity and mortality.MethodsThis was a descriptive prospective study which was conducted at Bugando Medical Centre between July 2006 and June 2010. All patients with a clinical diagnosis of obstructive jaundice were, after informed consent for the study, consecutively enrolled into the study. Data were collected using a pre-tested structured questionnaire and analyzed using SPSS computer software version 11.5.ResultsA total of 116 patients were studied. Females outnumbered males by a ratio of 1.3:1. Patients with malignant obstructive jaundice were older than those of benign type. Ca head of pancreas was the commonest malignant cause of jaundice where as choledocholithiasis was the commonest benign cause. Abdominal ultrasound was the only diagnostic imaging done in all patients and revealed dilated intra and extra-hepatic ducts, common bile stones and abdominal masses in 56.2%, 78.9%, 58.1% and 72.4% of the cases respectively. A total of 110 (94.8%) patients underwent surgical treatment and the remaining 6 (5.2%) patients were unfit for surgery. The complication rate was 22.4% mainly surgical site infections. The mean hospital stay and mortality rate were 14.54 days and 15.5% respectively. A low haematocrit and presence of postoperative sepsis were the main predictors of the hospital stay (P < 0.001), whereas age > 60 years, prolonged duration of jaundice, malignant causes and presence of postoperative complications mainly sepsis significantly predicted mortality (P < 0.001).ConclusionObstructive jaundice in our setting is more prevalent in females and the cause is mostly malignant. The result of this study suggests that early diagnosis and treatment plays an important role in the prognosis of patients with obstructive jaundice.

Predictors of outcome among patients with obstructive jaundice at Bugando Medical Centre in north-western Tanzania

“…Similar observation has been reported in a recent study by Chalya et al (2011). The duration of illness has been reported to be an important predictor of outcome in patients with obstructive jaundice (Han et al, 2003).…”

“…In this review, patients with malignant obstructive jaundice were found to be older than those of benign type. Similar age distribution was also reported previously by Chalya et al (2011) at the same centre.…”

“…As reported by other authors (Moghimi et al, 2008;Chalya et al, 2011), age > 60 years significantly predicted mortality. High mortality rate among patients in this age group may be attributed to their poor surgical risks.…”

“…The majority of patients in this study had malignant obstructive jaundice which is in agreement with other studies (Nakayama et al, 1978;Moghimi et al, 2008;Khurram et al, 2008;Syed et al, 2010;Chalya et al, 2011), but in contrast to Bekele & Yifru (2000) in Ethiopia who reported benign obstructive jaundice (choledocholithiasis) as the most common cause of obstructive jaundice. These observations reflect differences in etiological spectrum from one geographical area to another.…”

“…These observations reflect differences in etiological spectrum from one geographical area to another. In the present study, the malignant cause of obstructive jaundice was found to be significantly associated with high postoperative complication and mortality rates reported in another study in Tanzania (Chalya et al, 2011). High postoperative complication and mortality figures in the present study may be attributed to by the fact that patients with malignant obstructive jaundice were older with poor surgical risks than those of benign type.…”