A clinical study of obstructive jaundice secondary tocholedocholithiasis

Abstract

Background: Jaundice is known to mankind since time immemorial. The general surgeon frequently encounters obstructive jaundice. Obstructive jaundice in a patient can be due to intrahepatic or extrahepatic obstruction. Abdominal ultrasound is the preferred first radiological examination in most patients in whom biliary tract obstruction is suspected. Aim & Objectives: This study is done to know the incidence of obstructive jaundice due to choledocholithiasis in my hospital, its clinical presentation, role of ultrasound in diagnosing such cases and different modalities of treatment instituted at Kamineni Institute of Medical Sciences, Hyderabad. Methods: This is a study of 20 patients of obstructive jaundice secondary to choledocholithiasis who presented to Kaminenei Institute of Medical Sciences between June 2017 to June 2019. These patients subsequently underwent surgical interventions. All these patients have been thoroughly assessed both pre-operatively and post-operatively as per the proforma. Results: The hospital based incidence of obstructive jaundice secondary to choledocholithiasis was 0.14%. Most of the patients were females with ratio of 16:4. Patients presented with following symptoms in decreasing order of frequency. Jaundice (100%), pain abdomen (90%), dyspepsia/nausea/vomiting (45%), itching (30%), loss of appetite and weight (25%), fever with chills and rigors (20%), steatorrhoea (5%) and mass abdomen (5%) of the cases. The ultrasound detected stones in CBD 17 cases (85%) and dilated CBD in all 20 cases (100%). Choledocholithiasis was found in 11 cases. Choledocholithiasis and cholelithiasis was present in four cases. While one case of choledocholithiasis with CBD stricture was encountered during the study. In most of the cases the operative procedure was choledochoduodenostomy (45%) followed by choledochotomy with T-tube drainage 35%. Choledocho-jejunostomy and Transduodenal sphincter procedure was done in two case each. In all twenty cases cholecystectomy was performed. All the cases were followed up for a varying period from 1-6 months with no complaints. Conclusion: In the past bile duct surgery was accompanied by significant morbidity and mortality, with recent advances in supportive care, the numbers are decreasing. Obstructive jaundice secondary to gallstones in the CBD remains the commonest cause Obstructive jaundice patients are also prone for infections because of poor liver function, which can affect immunity. It is also important to identify individual risk factors in all the patients undergoing biliary tract surgery. Even though this is an era of laparoscopic CBD exploration, places where the technology and expertise are not available, open, internal and external biliary drainage procedures are still followed with good results.