A prospective study of clinico-radiological assesment and management of obstructive jaundice in Mmimsr, Mullana

Authors

  • Karaninder Singh Wilku Department of Surgery, Sri Guru Ram Das Institutes of Medical Sciences and Research, Vallah, Sri Amritsar,Punjab, India
  • Himank Gandhi Department of Surgery, Sri Guru Ram Das Institutes of Medical Sciences and Research, Vallah, Sri Amritsar,Punjab, India

DOI:

https://doi.org/10.18203/2349-2902.isj20213694

Keywords:

Obstructive jaundice, ERCP, Hepaticojejunostomy, Dilated CBD, Dilated IHBR

Abstract

Background: Obstructive jaundice poses diagnostic and therapeutic challenges. This study was undertaken to highlight the clinical and radiological assessment of obstructive jaundice in our setting and to approach for early diagnosis and treatment before irreversible tissue insult sets in.

Methods: Present study was prospective study conducted at Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana, Ambala. Data were collected on prescribed proforma and analyzed stastically.

Results: A total of 50 patients were studied. It is more common in productive adult with the mean age of 51.04±12.40 years. The male to female ratio was 1:1.08. Majority of the patients were having benign pathology (62%) and choledocholithiasis was the commonest benign cause. Abdominal ultrasound was the diagnostic imaging done in all patients and revealed dilated CBD (>1 cm) in 78% cases, dilated IHBR in 96%of cases and multiple CBD stones in 78.3% of cases. CT was reserved for suspected malignant and MRCP was planned in stone or benign causes. 70% patients were selected for ERCP and 62% of patients underwent definitive open procedure viz choledocholithotomy (40%), hepaticojejunostomy (12%).

Conclusions: Obstructive jaundice in our study was more prevalent in females and the cause is mostly CBD stones. The result suggests that early diagnosis and treatment plays vital role in the prognosis of patients with obstructive jaundice.  

References

Roche SP, Kobos R. Jaundice in the adult patient. Am Fam Phys. 2004;69(2):299-304.

Mohamed S, Syed AI. Management of Obstructive Jaundice: Experience in a tertiary care surgical unit. Pak J Surg. 2007;23:23-5.

Ahmad I, Jan AU, Ahmad R. Obstructive Jaundice. J Postgrad Med Inst. 2001;15:194-8.

Briggs CD, Peterson M. Investigation and management of obstructive jaundice. Surgery (Oxford). 2007;25(2):74-80.

Sharma MP, Ahuja V. Aetiological spectrum of Obstructive Jaundice and the diagnostic ability of ultrasonography: A clinician’s perspective. Trop Gastroenterol. 1999;20:167-9.

Chalya PL, Kanumba ES, Mchembe M. Etiological spectrum and treatment outcome of Obstructive jaundice: A diagnostic and therapeutic challenges. BMC Res Notes. 2011;4:147.

Allen B, Bernhoft R, Blanckaert N, Svanvik J, Filly R, Gooding G, et al. Sludge is calcium bilirubinate associated with bile stasis. Am J Surg. 1981;141:51-6.

Goyani B, Ukani B, Patel M, Shah B, Vadel M. Ultrasonography and magnetic resonance cholangiopancreatography correlation in patients with obstructive jaundice. Int J Med Sci Public Health. 2015;4(7):1010-4.

Iqbal JA, Khan ZA, Afridi FG, Alam AW, Alam MO, Zarin MO et al. Causes of obstructive jaundice. Pak J Surg. 2008;24:12-4.

Irabor DO. The Risk of Impaired Coagulation in Surgical Jaundice: An analysis of routine parameters. Surg Sci. 2012;3:116-9.

Obaidi SA, Al-Hilli MRA, Fadhel AA. The Role of Ultrasound and Magnetic Resonance Imaging in the Diagnosis of Obstructive Jaundice. The Iraqi postgraduate medical journal. 2007;6(1):7-17.

Shetty TS, Ghetla SR, Shaikh ST. Malignant obstructive jaundice: A study of investigative parameters and its outcome. J. Evid. Based Med. Healthc. 2016;3(69):3752-9.

Jabur AH, Sulaiman TI, Turky HA. Management of obstructive jaundice due to common bile duct stone. J Fac Med Baghdad. 2014;56(3):283-6.

Distler M, Kersting S, Ruckert F, Dobrowolski F, Miehlke S, Grützmann R et al. J Pancreas (Online). 2010;11(6):568-74.

Ling W, Hua S. A retrospective analysis of ultrasonic diagnosis for 360 cases of extrahepatic obstructive jaundice. Chinese medical journal. 2014;94(32):2522-4.

Umeshchandra DG, Jayabrata M. Clinical Study of Obstructive Jaundice. SAS J. Surg. 2015;1(3):105-18.

Dixon, Armstrong, Duffy, Davies. Factors affecting morbidity and mortality after surgery for obstructive jaundice: a review of 373 patients. Gut. 1983;24:845-52.

Saddique M, Iqbal SA. Management of obstructive jaundice: Experience in tertiarycare surgical unit. Pakistan journal of surgery. 2007;1(23):23-5.

Garcea G, Wee N, Neal CP, Dennison AR, Berry DP. Bilirubin levels predict malignancy in patients with obstructive jaundice. HPB. 2011;13:426-30.

Suthar M, Purohit S, Bhargav V, Goyal P. Role of MRCP in Differentiation of Benign and Malignant Causes of Biliary Obstruction. Journal of Clinical and Diagnostic Research. 2015;9(11):TC08-12.

Rishi M, Abdunnisar M, Suresh H. Value and accuracy of multidetector Computed Tomography in obstructive jaundice. Panacea Journal of Medical Science. 2015;5(3):137-44.

Mairiang P, Bhudhisawasdi V, Borirakchanyavat V, Sitprija V. Acute renal failure in obstructive jaundice in cholangiocarcinoma.Arch Intern Med. 1990;150(11):2357-60.

Malik A, Bari S, Riaz M, Wani N, Amin R. Preoperative biliary drainage and its effect on outcome of surgical obstructive jaundice. Internet J Surg. 2007;17(1):1-8.

Shetty TS, Ghetla SR, Shaikh ST. Malignant obstructive jaundice: A study of investigative parameters and its outcome. J. Evid. Based Med. Healthc. 2016;3(69):3752-9.

Irabor DO. The pattern of fall of serum bilirubin after operative relief of obstructive jaundice. Rev Cienc Salud Bogota Colombia. 2009;7(2):8-14.

Weston BR, Ross WA, Wolff RA, Evans D, Lee JE, Wang X et al. Rate of Bilirubin Regression After Stenting in Malignant Biliary Obstruction for the Initiation of Chemotherapy. Cancer. 2008;112:2417-23.

Mansfield SD, Sen G, Oppong K, Jacques BC, Suilleabhain CBO, Manas DM et al. Increase in serum bilirubin levels in obstructive jaundice secondary to pancreatic and periampullary malignancy implications for timing of resectional surgery and use of biliary drainage. HPB. 2006;8:442-5.

Irabor DO. The Risk of Impaired Coagulation in Surgical Jaundice: An analysis of routine parameters. Surg Sci. 2012;3:116-9.

Keighley MRB, Razay G, Fitzgerald MG. Influence of diabetes on mortality and morbidity following operations for obstructive jaundice. Birmingham Annals of the Royal College of Surgeons of England. 1984;66:49-51.

Kushwah APS, Jain S, Agarwal R, Tomar SP. Biliary tract obstructive diseases: A comparative evaluation by ultrasonography and magnetic resonance cholangiopancreatography (Magnetic Resonance Imaging). International Journal of Scientific Study. 2015;3(4):149-53.

Petrescu I, Bratu AM, Petrescu S, Popa BV, Cristian D, Burcos T. CT vs. MRCP in choledocholithiasis jaundice. J Med Life. 2015;8(2):226-31.

Singh A, Mann HS, Thukral CL, Singh NR. Diagnostic accuracy of MRCP as compared to ultrasound/CT in patients with obstructive jaundice. Journal of clinical and diagnostic research. 2014;8(3):103-7.

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Published

2021-09-28

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Original Research Articles