RESUMEN
Gallstone ileus is an uncommon cause of intestinal obstruction in Ghana. A patient with gallstone ileus that was diagnosed intra-operatively after being treated conservatively as adhesive small bowel obstruction for ten days is reported to highlight the importance of the clinical information in this condition. A 60-year-old Chinese male with recurrent intestinal obstruction who was initially being managed at a primary healthcare facility was subsequently referred to a tertiary hospital on account of computer tomography diagnosis of an intraluminal object obstructing the bowel. He had hypokalaemia that was corrected before surgery. Intra-operatively, a 4.5cm in diameter gallstone was removed from the terminal ileum. Gallstone ileus is rare in Ghana. A high index of suspicion is required to avoid a delay in diagnosis due to the low incidence of cholelithiasis in Ghana. Funding: None declared.
RESUMEN
Background: Obstructive jaundice is a term that describes the clinical entity of yellowness of the skin and mucous membranes due to the inability of bile to flow freely into the duodenum. This is commonly due to mechanical or physiological blockage of either the intrahepatic or extrahepatic bile ducts. Malignancies are responsible for the most cases of obstructive jaundice in our locality. Aim: The study sought to analyse all cases of obstructive jaundice that presented to a tertiary referral centre over a 36-month period, to determine the age at presentation, sex distribution, and aetiological spectrum. Study Design: Retrospective cross-sectional study. Study Setting: Korle-Bu Teaching Hospital, Accra, Ghana. Materials and Methods: This was a hospital-based study of all cases of obstructive jaundice that were seen over a 36-month period from May 2017 to April 2020, at the Hepatobiliary Unit of the Korle-Bu Teaching Hospital. The unit serves as a referral centre for all liver, pancreas, and biliary tract cases, including cases presenting with obstructive jaundice. The demographic data and diagnosis of all cases of obstructive jaundice seen over the study period were retrieved from both out-patient and in-patient records. Results: Three hundred and sixty cases of obstructive jaundice were studied; 141 (39.2%) were males and 219 (60.8%) were females, giving a male-to-female ratio of 1:1.6. The mean age of the patients was 56.8 (SD, 15.9) years. Malignant conditions accounted for 314 (87.2%) cases, whilst 46 (12.8%) were due to benign conditions. The mean age of the patients with benign conditions (40.4 [SD, 15.7] years) was significantly lower than that of those with malignant conditions (59.4 [SD, 14.9] years) (P < 0.0001). There was no significant difference in sex ratios between patients with malignant and benign causes (P = 0.996). Pancreatic head cancer was the commonest malignant cause of obstructive jaundice accounting for 139 (38.61%), followed by gallbladder tumour, 81 (22.5%), whilst choledocholithiasis (23 [6.39%]) was the commonest benign cause of obstructive jaundice. Conclusion: Obstructive jaundice in our setting was more prevalent in females. Malignant aetiologies were more common than benign ones: pancreatic head and gallbladder cancers were the commonest malignancies, whilst choledocholithiasis was the commonest benign cause. Malignant causes occurred in older patients than benign conditions, but there was no difference in sex ratios between the two categories.