A Study on the Demographic Characteristics and the Spectrum of Ct Findings in Adult Patients With Obstructive Jaundice - With Ultrasound and Histopathological Correlation at the Kenyatta National Hospital

Abstract

Background: Hepatobiliary disease is a major cause of morbidity and mortality worldwide. Biliary obstruction presenting clinically as obstructive jaundice has been identified as a major complication of these diseases. In the United States (2018), biliary obstruction had an incidence of approximately 5 cases per 1000 people. According to the Health Information Department at the Kenyatta National Hospital (2016-2020), obstructive jaundice contributed to 1.5% of all surgical admissions, 25% of all adult hepatobiliary diseases, and a 30% case fatality rate. Obstructive jaundice is caused by various conditions, including gallstones, strictures, pancreatic mass lesions, hepatic and biliary tree malignancies. Cross-sectional imaging has proven helpful in the detection of such lesions. There is limited data on the disease burden and the imaging characteristics of the different causes of obstructive jaundice in the region. Therefore, this study proposes to determine the demographic distribution and the spectrum of diseases causing obstructive jaundice using CT imaging at the Kenyatta National Hospital. Objective: To evaluate the spectrum, frequency, age, and sex distribution of conditions causing obstructive jaundice using CT scanning, to compare these findings with ultrasound findings and to correlate the imaging findings with histopathology results. Materials and Methods: An analytical cross-sectional study that was conducted over a period of one year from January 2022 to December 2022 at the Radiology department of the Kenyatta National Hospital. Using a purposive sampling technique, 31 patients with clinical and/or ultrasound features of obstructive jaundice were recruited. They were subjected to CT scanning of the hepatobiliary system using the triple phase protocol. A review of the images was done in the respective reporting rooms and the findings were verified by a consultant radiologist. In liaison with the surgical, Interventional Radiology and Pathology departments, follow up of the histopathology results was done. The demographic data and the spectrum of findings at CT and histopathology were keyed in Microsoft Excel and imported to IBM SPSS version 23.0 for analysis. Results: The distribution of ages ranged from 25 to 76 years. The mean age was 54.32 +/-14.1 years. The median age was 54 with an interquartile range of 43.0-68.0). 18 participants were female and 13 were male. 100% of the patients were of the black race. The most common age group belonged to the 60-69 and 40-49 age groups, at 25.8% respectively. Ultrasonography detected an obstruction in 77.4% of the cases. CT detected an obstruction in 100% of the patients. 30 patients had malignant disease and 1 had benign disease. The most frequent diagnosis given at CT evaluation was pancreatic adenocarcinoma at 32.3%, xv cholangiocarcinoma at 19.4%, periampullary tumors at 12.9%, gallbladder carcinoma at 6.5%, and choledocholithiasis at 3.2%, among other diagnoses. 58.1% of the patients had an obstruction at the distal CBD level, followed by hilar level (29%), and proximal CBD level (12.9%). Histopathology confirmed malignant disease in 30 patients, with a male to female ratio of 1:1.8. only 1 female patient had benign disease (choledocholithiasis). With a P value of 0.235 no significant difference was seen in the prevalence of obstructive jaundice between the males and females. At histopathology, 41.9% of the patients had pancreatic adenocarcinoma, 16.1% had cholangiocarcinoma and metastatic disease respectively, 9.7% had gallbladder adenocarcinoma, 6.5% had periampullary carcinoma, 3.2% had choledocholithiasis, among other diagnoses. 90% of patients with malignant histopathology was in the >40 years age groups and a single patient with benign disease was in the <40 years age groups. When compared to histopathology as a gold standard, CT correctly diagnosed the specific causes of obstruction in 90.3% of the patients. The level and type of obstruction were correctly determined in 100% of the patients. With a P value of 0.285, there was no significant difference between CT and histopathology as diagnostic tests. Conclusion: Obstructive jaundice is more common in our setting, with the most prevalent causes being malignant disease. CT correctly diagnosed the specific cause, the level and type of obstruction in most of the patients, making it an ideal diagnostic work up tool in evaluating the spectrum and frequency of conditions in obstructive jaundice