閉塞性黄疸の理解：原因と治療法

タイトル: Clinicopathological, surgical management and early postoperative outcome among obstructive jaundice inpatients at Kilimanjaro Christian Medical Centre from March 2020 to March 2023

概要: Obstructive jaundice is a surgical condition that affects all age groups mostly to the above 18 individuals. This condition can lead to high morbidity and mortality if not early diagnosed and treated. It remains the common cause of surgical consultations globally accounting for 8-10/100,000 and 242/1000 annually in China and Saudi Arabia respectively. Clinicopathological and radiological investigations are the key to the disease diagnosis. Cholelithiasis and cancer head of pancreas are common causes of obstructive jaundice. Although the diagnosis and treatments of obstructive jaundice is advancing; some patients get poor treatment outcome such as SSI, peritonitis and long hospital stay with some of them dying. To determine the clinicopathological, surgical management and early postoperative outcome among obstructive jaundice inpatients at KCMC from March 2020 to March 2023. A hospital-based cross-sectional study was conducted using secondary data from hospital records, EHMS system, surgery admission and theater registry books. All files of patients aged 18 years and above from these registry books with a diagnosis of obstructive jaundice from March 2020 to March 2023 were included. The obtained data were collected using the questionnaire then entered and analyzed using SPSS version 26. A total of 101 patients were studied, with the male to female ratio of 1.2:1. Cancer head of pancreas was the commonest malignant cause of obstructive jaundice where as choledocholithiasis was the commonest benign cause. Most of the clinical presentations were abdominal pain 47.6%, yellowish discoloration of the mucous membrane, eyes and skin by 43.6% and itching by 6.9%. Both laboratory investigations and radiological imaging were done which showed elevated liver enzymes 68.3%, low Hb 46.5%, histopathology 62.4%; benign and malignant obstructive jaundice cause by 33.7% and 46.5% respectively. Among all the patients who were surgically managed 29.7% had palliative triple bypass, 14.8% had laparoscopic cholecystectomy and 14.8% had CBD Exploration. The overall complication rate was 50.5%; Death 16.5% surgical site infections 13.9% and long hospital stay 9.9%. Obstructive jaundice in our setting is more common in males where malignant causes being high in the list