Clinicopathological features and management of obstructive jaundice at Queen Elizabeth Central Hospital, Malawi. A retrospective cohort analysis

Abstract

IntroductionThe diagnosis of obstructive jaundice (OJ) is a challenge and is often made late in low-resource settings. There is a paucity of data on the aetiology and prognosis of patients with obstructive jaundice in Malawi and Sub-Saharan Africa. The objective of this study was to determine the aetiology, clinical presentations, and short-term treatment outcomes of patients managed for OJ at Queen Elizabeth Central Hospital in Blantyre, Malawi. MethodologyA review of case notes of all patients admitted with a clinical diagnosis of obstructive jaundice from 2012 to 2022. We reviewed the clinical presentation, laboratory findings, management, intra and post–operative complications, and patient outcomes. Data was entered into an Excel spreadsheet and analysed using SPSS version 25. ResultsAges varied from 16 to 89 years. Females were 45 (58.4 %) of the study population. The commonest presenting complaint was jaundice followed by abdominal pain and distention. The mean duration of symptoms at presentation was 8.5 weeks. The most frequent imaging modality was abdominal ultrasound 50(65 %). Twenty-six patients (33.8 %) were discharged with a diagnosis of obstructive jaundice of undetermined pathogenesis. The commonest diagnosis was pancreatic cancer 17(22.1 %) followed by Choledocholithiasis11(14.3 %). Patients younger than 50 years had the same likelihood of presenting with cancer as those older than 50 years. ConclusionAll adult patients presenting with obstructive jaundice should be approached with a high index of suspicion for malignancy.