Obs Jaundice Accepted
Obs Jaundice Accepted
Please cite this article in press Fatima Mohammed Alrashed et al., Obstructive Jaundice: Incidence, Etiology and
Management In Aseer Region, Saudi Arabia., Indo Am. J. P. Sci, 2018; 05(12).
included in this study. The majority of included represents (59) 28% , figure 1.
patients were females 139 (72.02%), while males
According to age distribution of patients, results presented in table 1 shows that the age range was within 18-109
(43.89±19.48) years. It shows that about half of patients were aged more than 40 years, while the most common
age group was 26-32 years old.
The majority of patients were living in Abha city (70%), followed by Khamis Mushet (6%), and Mahayel (3%)
as shown in table 2.
Frequency Percent
Abha 137 70.3%
Al-Ahad 1 0.5%
Aldarb 1 0.5%
Almujaredah 1 0.5%
Alnemas 1 0.5%
Bani Malik 1 0.5%
Jazan 5 2.6%
Khamis Mushet 12 6.2%
Mahayel 6 3.1%
Rujal Alma 1 0.5%
Sarat Abedah 3 1.5%
Tathleeth 1 0.5%
Other 25 12.8%
Total 195 100.0%
The mean of BMI of the patients was (28.37±8.33Kg/m2). The majority were overweight (45.45%) followed by
31% who were within the normal range. Obese patients were 22% of cases and only 2% of were underweight as
shown in figure 2.
Figure 2: Frequency of different body mass index values for involved patients:
Concerning etiology of obstructive jaundice, the results showed that most of patients were presented with gall stones
(82%), while 12.6% were presented with narrowing of the bile duct. Cysts and pancreatic cancer were
Identified in 3.7% for each. Pancreatitis was reported in 1.6%, liver cancer in 1.1%, and the least presentation
(0.5%) was with gallbladder cancer and mirrizi syndrome as shown in table 3.
It was clear that the most common way in managing patients with obstructive jaundice was the endoscopic
retrograde cholangio-pancreatography (ERCP) which was done for more than half of reviewed patients (51%).
were done for 37% of included patients. In addition, the least commonly used ways in obstructive jaundice
management were “Removal of ERCP Stent”, “Hepatobiliary surgery” and “ERCP + MRCP (magnetic
resonance cholangio-pancreatography)” as shown in table 4.
Frequency Percent
ERCP 100 51.3%
Choleocystomy 72 36.9%
ERCP and cholecystectomy 8 4.1%
Conservative 6 3.1%
Refuse treatment plan 3 1.5%
Removal of ERCP Stent 2 1.0%
Hepatobiliary surgery 2 1.0%
ERCP + MRCP 2 1.0%
Total 195 100.0%
The complications after treatment were reviewed, the findings showed that only 4 patients had complications, 2
of them suffered from cholangitis, while one patient had bile duct injury, and the other one had had pancreatitis.
Concerning the outcomes of treatment using different treatment modalities, around 93% of the patients had
improved and were discharged, while 7% didn’t show any signs of improvement as shown in table 5.
By studying the relationships between background characteristics of patients and their treatment outcomes, we found
that the relation between patient’s BMI and either if patient improved or not was not statistically significant (p-
value = 0.569). On the other hand, we shall highlight that all underweighted patients were improved, as shown in
table 6.
Table (6): Relation between body mass index of patients and their treatment outcomes
Treatment outcomes
BMI P-value
Improved Not improved
Underweight 4 (2.3%) 0 (0)
Normal range 53 (30.8%) 3 (21.4%)
0.569
Overweight 79 (45.9%) 6 (42.9%)
Obese 36 (20.9%) 5 (35.7%)
However, the relation between management ways and its outcomes were statistically significant (p-value<0.001).
Those patients who did “Cholecystectomy”, ERCP with MRCP, or ERCP with cholecystectomy all are
improved. Two patients who did Hepatobiliary surgery did not show any signs of improvement as shown in table
7.
In addition, there were a significant relation between etiology and treatment outcome of the patient's condition
(p-value <0.001). Ninety five percent of those patients who had gall stones were improved, while only 5% of
them were not improved. Table 8 shows that all patients with cysts, pancreatitis and mirrizi syndrome were all
improved. On the other hand, it seems like three quarters of patients with Pancreatic cancer were not improved.
In the same way, the relation between patient’s age and the management way was statistically significant.(p-
value <0.001)
Table (8): Relation between etiology of obstructive jaundice and treatment outcomes:
OUTCOME
Etiology Improved Not improved P-value
No. % No. %
Gall Stones 148 94.9% 8 5.1%
Cysts 7 100.0% 0 .0%
Narrowing of the bile duct 22 91.7% 2 8.3%
<0.001
Pancreatitis 3 100.0% 0 .0%
Pancreas cancer 2 28.6% 5 71.4%
Liver cancer 0 .0% 0 .0%
DISCUSSION: liver cancer in 1%, and the least etiology was the
gallbladder cancer (0.5%). These findings agree with
The objectives of this study were to identify the most
Chandra Roy et al, (10) whose results showed that
common etiology of the disease, the most commonly
Choledocholithiasis represent the most common
used treatment modalities and their outcomes. the
cause of benign obstructive jaundice (26%), followed
secondary objectives were to detect if there is a
by biliary stricture (8%) and cysts represent (4%).
relation between age, BMI and obstructive jaundice.
While its results represent higher percentages of
Therefore, the study included all surgical cases of
malignant causes where pancreatic cancer represents
obstructive jaundice aged 18 years and above
30% of cases and cancers of gallbladder represents
admitted at Aseer Central Hospital for a whole one
22% of cases. In addition, the study findings also
year.
agree with V. Gopalakrishna (9) whose results
Studies on gastrointestinal diseases are important showed that choledocholithiasis represent the most
studies because they have a role in detection of the common cause of obstructive jaundice (43%) and that
causes of the disease and developing appropriate narrowing of bile duct represent 14% of cases and
solutions to reduce its incidence. pancreatic cancer represent 5% of cases.
The mean age for our patients was 43.9 years which However, our results concerning etiologies are
is nearly similar to Ankur Attri et al,(8) whose results different from E. Björnsson et al, (11) study which
showed that the mean age for patients with was done in Gothenburg hospitals, Sweden which
obstructive jaundice is 50 years and also similar to V. showed that the most common cause of jaundice was
Gopalakrishna et al,(9) whose results showed that malignancy (33.5%) followed by alcoholic liver
mean age for patients is 40 years. disease which was the second most common cause
representing (16.7%), followed by bile duct stones
Our results showed that females (72%) are more
(16.1%).
affected by obstructive jaundice than males (28%)
and this agrees with Chandra Roy et al (10) whose This difference may be due to different demographic
results showed that obstructive jaundice including its characters, higher values of bilirubin in E. Björnsson
benign and malignant causes are more prevalent in (11) study and also his study involved causes of
females more than males. V. Gopalakrishna (9) hepato-cellular and obstructive jaundice together.
reported similar findings which showed that 60% of
Different findings were reported by Ankur Attri (8)
patients are females and 40 % of them are males.
study which showed that strictures represent 32% of
Concerning etiologies of obstructive jaundice, our cases, choledocholithiasis represent 16% of cases;
study results showed that most of patients presented but agrees with it in that each of choledochal cyst and
with gall stones (82%), while narrowing of the bile mirrizi syndrome represent 2% of cases.
duct percentage was 12.6%, cysts and pancreatic
Concerning the different management modalities for
cancer were (3.7%) separately. Pancreatitis was
obstructive jaundice, our results showed that the most
reported as a cause for obstructive jaundice in 1.6%,
commonly used method is ERCP (51.3%) and that
cholecystectomy was used in 36.9% of cases. This for malignant obstructive jaundice: a
agrees with Adam RH et al (12) whose results review. World journal of gastroenterology, 6(5),
showed that ERCP is used in 54% of obstructive 643.
jaundice cases treatment and cholecystectomy was 4. Clarke, D. L., Pillay, Y., Anderson, F., &
used in 33% of cases. Thomson, S. R. (2006). The current standard of
care in the periprocedural management of the
Concerning the outcomes of management methods
patient with obstructive jaundice. The Annals of
used in treatment of obstructive jaundice cases, our
the Royal College of Surgeons of England, 88(7),
results showed that 90% of patients who undergo
610-616.
ERCP have been improved completely while only
5. Addley, J., & Mitchell, R. M. (2012). Advances
10% did not improve and this agrees with Suissa A et
in the investigation of obstructive
al,(13) whose results showed that success rate after
jaundice. Current gastroenterology
ERCP was 92%.
reports, 14(6), 511-519.
Concerning complications of treatment methods, our 6. Stern, N., & Sturgess, R. (2008). Endoscopic
results showed that only 2% of cases developed therapy in the management of malignant biliary
complications from which 0.5% presented with obstruction. European Journal of Surgical
pancreatitis. These proportions are less than those Oncology (EJSO), 34(3), 313-317.
presented by Suissa A et al, (13) whose results 7. Shojaiefard, A., Esmaeilzadeh, M., Ghafouri,
showed that 10% of cases presented with A., & Mehrabi, A. (2009). Various techniques
complications from which 4% developed pancreatitis. for the surgical treatment of common bile duct
stones: a Meta review. Gastroenterology
research and practice, 2009.
CONCLUSION / RECOMMENDATIONS: 8. Ankur Attri, Ritu Dhawan Galhotra, Archana
Ahluwalia, Kavita Saggar. (2016) Obstructive
We conclude from this study that the incidence of jaundice: Its etiological spectrum and
obstructive jaundice is 242 per 1000 surgical cases. radiological evaluation by magnetic resonance
Females and adults between 22-35 years are at a cholangiopancreatography. Medical journal of
higher risk of obstructive jaundice. The most Dr.D.Y Patil Vidyapeeth, vol.9 (4) pp.443-450.
common causes of obstructive jaundice are gallstones 9. V. Gopalakrishna,P. Shravankumar, M.
or pancreatic cancer. The most common treatment Umadevi (2017) Profile of Obstructive Jaundice
interventions were ERCP and cholecystectomy which in Tertiary Referral Hospital, journal of clinical
were associated with more than 90% improvement and experimental Hepatology, volume7(2): p
rate. s97.
This high improvement rate could be attributed to 10. Chandra Roy, Md. Abu Hanifa, Md. Shafiul
many factors such as the increasing governmental Alam, Saimun Naher, Prosannajid Sarkar,
support for the hospitals, the use of advanced medical PhD, B. (2015). Etiological Spectrum of
technology and equipment, and the recruitment of Obstructive Jaundice in a Tertiary Care
highly qualified healthcare professionals. Hospital. Global Journal of Medical Research,
Retrieved
from https://medicalresearchjournal.org/index.ph
ACKNOWLEDGEMENT: p/GJMR/article/view/1002
We are grateful to all those who provided us with 11. E. Björnsson, S. Ismael, S. Nejdet & A.
invaluable training and administrative support Kilander (2003) Severe Jaundice in Sweden in
including all the members of the Health Research the New Millennium: Causes, Investigations,
Consultancy Office. Treatment and Prognosis, Scandinavian Journal
of Gastroenterology, 38:1, 86-94.
REFERENCES: 12. Adam, R. H., Elshiekh, A. A., & Mohammed,
1. Modha, K. (2015). Clinical approach to patients M. I. (2016). Pattern and Management of
with obstructive jaundice. Techniques in Obstructive Jaundice in Wad Medani Teaching
vascular and interventional radiology, 18(4), Hospital, March 2014-2015. Gezira Journal of
197-200. Health Sciences, 12(1).
2. Roy, B. C., Hanifa, M. A., Alam, M. S., Naher, 13. Suissa A, Yassin K, Lavy A, Lachter
S., & Sarkar, P. (2015). Etiological Spectrum of J, Chermech I, Karban A, Tamir A, Eliakim
Obstructive Jaundice in a Tertiary Care R.(2005) Outcome and early complications of
Hospital. Global journal of medical research. ERCP: a prospective single center study.
3. Kozarek, R. A. (2000). Metallic biliary stents Hepatogastroenterology. 52(62):352-5.