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July 2017 Vol. 5 No.7

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Agbo SP
Oboirien M

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Merit Research Journal of Medicine and Medical Sciences (ISSN: 2354-323X) Vol. 5(7) pp. 349-353, July, 2017 

Copyright © 2017 Merit Research Journals


Original Research Article

Obstructive Jaundice: A Review of Clinical Experience in Resource Limited Setting

 
 
 

S. P. Agbo* and M. Oboirien

 

Department of Surgery, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria

*Corresponding Author’s E-mail: agbostephen@yahoo.com

Accepted July 12, 2017

 

Abstract

 

Obstructive jaundice is a common clinical condition that is largely under–reported, especially from a resource limited setting like ours where it constitutes a major challenge to the surgeon due to the high morbidity and mortality associated with it. Most patients present to the surgical clinic directly or as referrals from peripheral hospitals and are usually in poor state. This study was undertaken to determine the common risk factors associated with obstructive jaundice in our sub-region and to highlight the management challenges in a resource limited country like Nigeria. A 3 -year retrospective review of case notes of patients with obstructive jaundice between 2013 and 2015 was carried out. Demographic characteristics, risk factors and management outcome were studied. A total of 78 patients were seen. Out of this, 64 were males while 14 were females giving a male: female ratio of 4.6:1.0 The age range was between 40 and 77 years. The mean age was 63.8 years, median age was 65.0 years and the modal age was also 65.0 years. 87.2% (68) of obstructive jaundice was caused by carcinoma of the head of the pancreas, 7.7%(6) was caused by common bile duct stones, 2.6%(2) by peri-ampullary carcinoma while cholangiocarcinoma (Klatskin tumor) and tuberculous peri-portal adenitis were each responsible for 1.3%(1) of cases of obstructive jaundice. Majority of the patients presented with Child - Pugh-’s grade B, 64.1%(50); while 24.4%(19 ) presented with grade C and 11.5%(9) with grade A. 38.5% (30) of patients were managed conservatively with antibiotics and chemotherapy while 51.3% (40) had triple by-pass; 5.1% (4) had an open cholecystectomy +common duct exploration while 2.6% (2) had a laparoscopic cholecystectomy + common duct exploration and 2.6%(2) also had an exploratory laparotomy + biopsy. Hypovolaemia in 25%(12) was the commonest post-operative complication followed by wound infection in 22.9%(11),fever in 18.8%(9), hepato-renal syndromein16.7%(8) and septic shock in 12.5%(6) respectively. Duodenal perforation was 2.1%(1) and hepatic encephalopathy also 2.1%(1). Post-operative mortality was 20.5% (16) while pre-operative mortality was 11.5% (9) making an overall mortality of 32.0 % (25). Carcinoma of the head of the pancreas was the commonest cause of obstructive jaundice in this study at 85.9%(67) followed by common bile stone duct at 7.7%(6). The management outcome of obstructive jaundice in Sokoto, Nigeria still remains dismal with an operative mortality of 20.5%(16) and an overall mortality of 32.0%(25).

Keywords: Obstructive jaundice, cancer head of pancreas, common duct stone.













 










 







































 










 

 
 
   
   
   
   
   
   
   
   
   
   
   
 
 
 
 
 
 
 
 
   
 
                         

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