Aetiology and challenges of managing obstructive jaundice in a resource-limited setting in South Western Nigeria

Abstract

Background: Obstructive jaundice is a common clinical condition with a varying diverse spectrum of aetiology from region to region and its management is often associated with challenges. Aims: To highlight the spectrum of aetiology, challenges, and limitations in the management of obstructive jaundice in a resource-limited setting. Patients, Materials and Methods: Prospective descriptive study over a period of seven years in two teaching hospitals in Nigeria. Patients with a diagnosis of obstructive jaundice between April 2015 and March 2022 were consecutively enrolled into the study. Relevant data were obtained through a pretested paper pro forma. Results: Eighty-four patients were studied. The mean age of the patients was 54.8 ± 2.1 with male to female ratio of 1.1: 1. Malignant cases were responsible for 84.5% of cases. The mean duration of the disease was 119.6 ± 13.7. All patients had an abdominal ultrasound scan done. Only 42.4% of patients could afford computed axial tomography (CAT), and other minimally invasive investigations were not available. The mean bilirubin level shows a statistically significant difference between benign and malignant cases (301 ± 9.8 vs. 398 ± 11.1; P < 0.001). Sixty-five (80.2%) patients were operated upon. Fifty-five (84.6) patients’ surgeries were delayed. None of the patients operated upon had intraoperative cholangiography due to lack of facility and no laparoscopic procedure was done. Conclusion: Obstructive Jaundice is a common surgical condition in our environment. The majority of cases were malignant in origin and delayed presentation and lack of modern diagnostic and therapeutic facilities were responsible for poor outcomes.