Abstract

Dr. Purujit Choudhury* and Dr. Touhidur Rahman

ABSTRACT

Background: Jaundice is a frequent manifestation of biliary tract disorders and the evaluation and management of obstructive jaundice is a common problem faced by the general surgeon. Obstructive jaundice of varied etiology is one of the causes of admission to hospitals across Guwahati Medical College & Hospital. To diagnose the cause, site of obstruction and management of a case of surgical jaundice is indeed a challenging task for the surgeon. Hence, a comprehensive study of the etiology, clinical presentation and management of obstructive jaundice is of paramount importance in the appropriate management of these patients. Aim: This study evaluates the age and sex distribution, clinical presentation, aetiology, and the different modalities of treatment of obstructive jaundice. Methods: This retrospective study was conducted in Guwahati Medical College and Hospital, Assam from June 2020 to June 2021. 100 cases of surgical jaundice of different age group were selected randomly. A detailed history and clinical examination was done and appropriate investigations recorded. Patients were assessed preoperatively and later subjected to surgery or palliative procedure depending on the need. Postoperatively, patients’ condition was assessed. Patients were followed up for mean period of 6 months where patients underwent surgical intervention/ERCP. Jaundice is a common problem in medical and surgical gastroenterological practice. Its cause can often be correctly anticipated clinically but usually investigations are required for confirmation. It could be because of a variety of causes and is less commonly seen outside the gastroenterology and hepatobiliary surgery.[3] Regarding surgical obstructive jaundice (jaundice due to intra or extrahepatic organic obstruction to biliary outflow), can present problems with the diagnosis and management.[4] Result: The occurrence of surgical jaundice was maximum in the 30-60 year age group and mean age was 45.5 years. All patients presented with icterus and ultrasonogram was the most common investigation of choice. Most common cause of obstruction was choledocholithiasis (58%) followed by malignancy (22%). ERCP with stone retrival/stenting was done in majority of patients (25). Conclisions: Commonest symptom of surgical jaundice in this study was jaundice as per history. Commonest cause for surgical jaundice was found to be choledocholithiasis. For CBD calculi, ERCP stone extraction and CBD exploration with cholecystectomy and drainage procedure was done by T tube or choledochoduodenostomy.