الفهرس 
& the pancreasAnatomy of the extra-hepatic biliary tractOnly 14 pages are availabe for public view
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Abstract
Obstructive jaundice is a current problem in surgery. Today, the number of patients operated upon for obstructive jaundice is two folds that operated upon for the same reasons in the 1980s.
Female predominance is noticed in the calcular cases, while male predominance is noticed in the malignant cases. The average age for the disease was around 50 years and 78% of cases were caused by benign disease.
Conventional ultrasound and color Doppler imaging are the imaging methods of choice in evaluation of obstructive jaundice and in the hand of experienced practitioner; it is equal in importance to endoscopy.
MRCP is a fast, non-invasive, and sensitive method of detection of bile duct stones, biliary dilation and stricture. MRCP does not replace ERCP. It is useful in cases who are pregnant, who have postoperative altered gastro pancreatic anatomy duo to surgery (in iatrogenic cases), and in cases of obstructive jaundice with non-dilated CBD.
ERCP was utilized to demonstrate pancreatic and peri-ampullary lesions, with reported complications including pancreatitis (5%), cholangitis, and bleeding. It was useful as a diagnostic and a therapeutic tool.
Cholecystectomy, choledochotomy, stone extraction, and choledochoduodenostomy were the most frequent method of treatment, mostly performed by laparotomy (with a single trial by laparoscopy).
Several risk factors were the subject of the study; four risk factors were noticed to be strongly correlated to postoperative mortality (malignancy, CBD diameter less than 1.5 cm, live cirrhosis, failure of preoperative decompression) while the other risk factors were noticed to be correlated to postoperative morbidity in addition to the previous risk factors, so postoperative morbidity and mortality can be predicted, avoided, and treated properly
. A scoring system was done from the analysed data in our study as follow:
1. Class 1 patients: from o-2 risk factors, expected morbidity is 39% with no expected mortality.
2. Class 2 patients: from 3-4 risk factors, expected morbidity is 50% with no expected mortality.
3. Class 3 patients: from 5-6 risk factors, expected morbidity is 66% with expected mortality 16%.
4. Class 4 patients: from 7-8 risk factors, expected morbidity is 75% with expected mortality 25%.
We conclude that the management of jaundiced patients with bile duct obstruction remains a significant problem. The better understanding of the factors related to post-operative morbidity and mortality in these patients will enable a more informed choice of appropriate surgical or non-surgical management and lead to improved survival.