Etiology, Clinical Presentations, and Short-Term Treatment Outcomes of Extrahepatic Obstructive Jaundice in South-Western Uganda
Date
2022-11-13Author
Charles Newton, Odongo
Carlos Cabrera, Dreque
David, Mutiibwa
Felix, Bongomin
Felix, Oyania
Mvuyo Maqhawe, Sikhondze
Moses, Acan
Raymond, Atwine
Fred, Kirya
Martin, Situma
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Show full item recordAbstract
Background: The diagnosis of extrahepatic obstructive jaundice (EHOJ) remains a challenge and is often made late in low-resource
settings. Systematic data are limited on the etiology and prognosis of patients with obstructive jaundice in Uganda. The objective of
this study was to determine the etiology, clinical presentations, and short-term treatment outcomes of patients managed for EHOJ at
Mbarara Regional Referral Hospital (MRRH) in south-western Uganda.
Methods: Between September 2019 and May 2020, we prospectively enrolled a cohort of patients who presented with EHOJ at
MRRH. A pretested, semi-structured data collection tool was used to abstract data from both the study participants and their files.
Results: A total of 72 patients, 42 (58.3%) of whom were male with a median age of 56 (range of 2 months to 95 years) were studied.
Forty-two (58.3%) participants had malignancies: Pancreatic head tumors 20 (27.8%), cholangiocarcinoma 13 (18.1%), duodenal
cancers 5 (6.94%), and gall bladder cancer 4 (5.6%). The remaining 30 (41.7%) participants had benign etiologies: choledocholithiasis
10 (13.9%), biliary atresia 7 (9.7%), pancreatic pseudo cyst 6 (8.3%), Mirizzi syndrome 5 (6.9%) and 1 (1.4%) each of chronic
pancreatitis and choledochal cyst. Sixty-seven (93.1%) patients presented with right upper quadrant tenderness, 65 (90.3%) abdominal
pain and 55 (76.3%) clay-colored stool. Cholecystectomy 11 (25.6%) and cholecystojejunostomy + jejunojejunostomy 8 (18.6%) were
the commonest procedures performed. Twelve (17.0%) of cases received chemotherapy (epirubicin/cisplatin/capecitabine) for pan creatic head tumors and (gemcitabine/oxaliplatine) for cholangiocarcinoma. Mortality rate was 29.2% in the study, of which
malignancy carried the highest mortality 20 (95.24%).
Conclusion: Malignancy was the main cause of EHOJ observed in more than half of the patients. Interventions aimed at early
recognition and appropriate referral are key in this population to improve outcomes.