Abstract

Background: Obstructive jaundice is a condition caused by blockage of the flow of bile out of the liver. This results in an overflow of bile and its by-products into the blood and bile excretion from the body is incomplete. Ultrasound (USG) is used to evaluate patients for biliary stones and cholecystitis. It can detect cystic duct and neck of the gallbladder obstruction as well as distension and inflammation of the gallbladder. It can identify carcinoma of the gallbladder, which is highly malignant and metastasize quickly. Magnetic resonance cholangiopancreatography (MRCP) is a relatively new noninvasive diagnostic technique for direct visualization of the biliary ducts through images similar to those produced in endoscopic retrograde cholangiopancreatography and percutaneous transhepatic cholangiography.

Objective: To highlight the role of ultrasonography and MRCP as preliminary investigation in patients with obstructive jaundice.

Materials and Methods: Thirty patients with complaints of jaundice and clinico-pathological appearance of obstructive jaundice were included in the study. The patients had undergone sonography of abdomen in radiology department and then MRCP study was conducted. Data of patients matching inclusion criteria were recorded after getting informed consent.

Result: Of 30 patients, 17 (56.66%) were females and 13 (43.33%) were males. Most common age group of patients was 51–60 years (23.3%) followed by 61–70 years (16.6%). Jaundice was the most frequent symptom (96%) followed by abdominal pain (86.66%). Common bile duct (CBD) was most commonly involved in 50% of cases followed by confluence of right and left hepatic duct and pancreas in 13.33%. Most common obstructive lesions in this study were congenital anomalies of CBD (choledochal cyst) in 30% cases followed by stone in CBD +/- CHD with or without stricture in 19.99% cases. In this study, of 30 cases, 16 (53.33%) were benign lesions and 14 (46.66%) were malignant. Among benign lesions, choledochal cyst was the most common (9/16; 56.25%), especially more among females. However, among malignant lesions, hilar cholangiocarcinoma was most common (5/14), especially among females. USG (30/30) was found to be equally good as MRCP (30/30) in detecting the presence and level of obstruction. In detecting the extent of obstruction, USG could not localize the distal extent of the lesion involving distal CBD (6/30) due to poor patient factors (obesity) and bowel gases. In assessing the cause of obstruction, MRCP (30/30) scored over USG.

Conclusion: USG is a cost-effective, noninvasive, and nonionizing easily available preliminary investigation in the evaluation of obstructive jaundice but MRCP scores over USG for evaluation of small hepatic metastasis in the presence of pancreaticobiliary malignancies that may be missed with USG.

Key words: Obstructive jaundice, ultrasonography, MRCP