Clinical Study of Obstructive Jaundice: Etiology, Clinical Presentation, Management and Outcomes at a Tertiary Centre in Vijayawada, Andhra Pradesh

Background: Obstructive jaundice is an important clinical and surgical problem caused by interruption of normal bile flow at the intrahepatic or extrahepatic level. Its etiological spectrum ranges from benign conditions such as choledocholithiasis to malignant disorders involving the pancreas, periampullary region and biliary tract. Appropriate evaluation requires integration of clinical findings, biochemical investigations and imaging, followed by endoscopic or surgical intervention according to the underlying cause [1–3]. The aim is to study the clinical presentation, etiological spectrum, management strategies and short-term outcome of patients presenting with obstructive jaundice at a tertiary-care teaching hospital – Siddhartha Medical College, Vijayawada. Material and Methods: A prospective observational study was conducted in the Department of General Surgery, Government General Hospital, Siddhartha Medical College, Vijayawada, over 15 months from December 2018 to March 2020. Thirty-five patients with obstructive jaundice fulfilling the study criteria were evaluated clinically and biochemically and underwent imaging with ultrasonography and contrast-enhanced computed tomography, with ERCP performed when indicated. Patients were managed according to the underlying pathology and operative findings and were followed for 6 months. Results: The study included 35 patients with a mean age of 47.34 years and an age range of 25–70 years. The most frequently represented age group was 41–50 years (31.4%). There were 20 males (57.1%) and 15 females (42.9%), giving a male-to-female ratio of 1.33:1. Jaundice was the commonest presenting complaint, occurring in 25 patients (71.4%), followed by abdominal pain in 21 (60.0%) and pruritus in 13 (37.1%). Loss of appetite/weight loss as a combined recorded variable was present in 10 patients (28.6%). Benign etiologies accounted for 26 cases (74.3%), while 9 (25.7%) were malignant. Cholelithiasis with common bile duct calculi was the commonest etiology, occurring in 24 patients (68.6%), followed by periampullary carcinoma/growth in 9 (25.7%) and pancreatic pseudocyst in 2 (5.7%). ERCP stenting followed by laparoscopic cholecystectomy was performed in 15 patients (42.9%), open cholecystectomy with CBD exploration in 5 (14.3%), triple bypass in 6 (17.1%), laparoscopic CBD exploration with laparoscopic cholecystectomy in 4 (11.4%), Whipple procedure in 3 (8.6%), and cystogastrostomy in 2 (5.7%). One postoperative death occurred following Whipple procedure. No recurrence was reported among survivors during 6 months of follow-up. Conclusion: In this cohort, benign biliary disease, particularly choledocholithiasis, was the predominant cause of obstructive jaundice. ERCP followed by laparoscopic cholecystectomy was the most frequently used treatment strategy for patients with gallstone-related CBD obstruction. Malignant disease was associated with more complex operative management and the only mortality observed in the study. Management should be individualized according to etiology, anatomical findings, patient fitness and available expertise.

Keywords: Obstructive jaundice; choledocholithiasis; ERCP; laparoscopic cholecystectomy; CBD exploration; periampullary carcinoma; biliary obstruction.