Obstructive jaundice--a diagnostic appraisal.

ABSTRACT

One hundred and eight suspected cases of obstructive jaundice (OJ) were analysed using ultrasonography, percutaneous transhepatic cholangiography (PTC) or Endoscopic retrograde cholangiopancreatography (ERCP) or both. Clinical evaluation had accuracy of 93% in identifying OJ and establishing aetiology in 62%, however, it lacked specificity. Ultrasonography was useful in differentiating obstructive jaundice from medical jaundice in 91% of cases. However, the cause and site of biliary obstruction could be identified in 55% and 46% respectively. PTC was helpful in detecting the site of obstruction in 80.4% and nature in 63% of cases. Its failures were mostly associated with the presence of metastasis in the liver. ERCP successfully attained cholangiography in 58% and pancreatogram in 70% of cases. Overall diagnostic yield of ERCP was 67% in view of additional endoscopic findings in 18 cases. The complications were occasional and could be managed effectively with medical treatment. This study suggests utility of clinical evaluation in OJ inspite of its poor specificity and comparative value of PTC and ERCP in establishing the site as well as nature of lesion.