Etiology, Clinical Presentations, and Short-Term Treatment Outcomes of Extrahepatic Obstructive Jaundice in South-Western Uganda.
Uganda
benign obstructive jaundice
malignant obstructive jaundice
Journal
Clinical and experimental gastroenterology
ISSN: 1178-7023
Titre abrégé: Clin Exp Gastroenterol
Pays: New Zealand
ID NLM: 101532800
Informations de publication
Date de publication:
2022
2022
Historique:
received:
29
01
2022
accepted:
31
05
2022
entrez:
20
6
2022
pubmed:
21
6
2022
medline:
21
6
2022
Statut:
epublish
Résumé
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. 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. 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 pancreatic 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%). 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.
Sections du résumé
Background
UNASSIGNED
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
UNASSIGNED
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
UNASSIGNED
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 pancreatic 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
UNASSIGNED
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.
Identifiants
pubmed: 35721671
doi: 10.2147/CEG.S356977
pii: 356977
pmc: PMC9199528
doi:
Types de publication
Journal Article
Langues
eng
Pagination
79-90Informations de copyright
© 2022 Odongo et al.
Déclaration de conflit d'intérêts
The authors report no conflicts of interest in this work.
Références
World J Gastroenterol. 2008 Sep 14;14(34):5282-9
pubmed: 18785280
Mol Clin Oncol. 2020 Aug;13(2):216-220
pubmed: 32714548
JOP. 2010 May 05;11(3):234-6
pubmed: 20442518
Asian J Surg. 2006 Jul;29(3):188-92
pubmed: 16877223
Med Oncol. 2008;25(1):12-21
pubmed: 18188710
Semin Liver Dis. 2004 May;24(2):189-99
pubmed: 15192791
Pancreatology. 2020 Jun;20(4):736-745
pubmed: 32386969
J Hosp Med. 2008 Mar;3(2):117-23
pubmed: 18438808
J Int Med Res. 2004 Nov-Dec;32(6):633-8
pubmed: 15587757
Langenbecks Arch Surg. 2016 Aug;401(5):715-24
pubmed: 27236290
Pediatr Transplant. 2013 Mar;17(2):95-8
pubmed: 23347466
J Surg Oncol. 2008 Feb 1;97(2):156-64
pubmed: 18050290
N Engl J Med. 1999 Oct 28;341(18):1368-78
pubmed: 10536130
Cancer Res Treat. 2017 Apr;49(2):473-483
pubmed: 27554480
Dig Dis. 2014;32(5):570-8
pubmed: 25034290
JAMA. 2005 Jan 19;293(3):330-9
pubmed: 15657326
Am Fam Physician. 2017 Feb 1;95(3):164-168
pubmed: 28145671
PLoS One. 2018 May 15;13(5):e0196475
pubmed: 29763444
Fam Pract. 2012 Aug;29(4):416-20
pubmed: 22247287
J Paediatr Child Health. 2016 Oct;52(10):944-949
pubmed: 27236017
Am J Clin Oncol. 2003 Aug;26(4):422-8
pubmed: 12902899
Tanzan J Health Res. 2013 Oct;15(4):216-22
pubmed: 26591696