High Prevalence of Malignancy in Obstructive Jaundice: A Cross-Sectional Study from Dongola, Sudan

Background: Obstructive jaundice is a clinical condition caused by obstruction of the bile flow system and manifests as discolouration of the eyes and skin. The prevalence of malignant jaundice in nearby African nations is unacceptably high. Furthermore, there is local suspicion that gold mining activities are behind the high number of cancer patients in the northern region of Sudan. This study aims to identify the prevalence of malignancy among obstructive jaundice patients in the study area. Methods: We performed a hospital-based cross-sectional review of 60 consecutive patients diagnosed with obstructive jaundice at three major hospitals in Dongola between January and July 2024. Malignancy was defined by imaging and histopathology. Data were extracted from hospital records and supplemented by telephone interviews when records were incomplete. Descriptive statistics, bivariate tests, and multivariable logistic regression were used to compare malignant and benign cases; significance was set at p < 0.05. Analyses were performed using SPSS v27. Results: Malignancy accounted for 31/60 (51.7%) of obstructive jaundice cases. The most frequent malignant diagnoses were hepatocellular carcinoma (9/31, 29.0%) and carcinoma of the pancreatic head (8/31, 25.8%). Malignant cases more often reported weight loss, vague abdominal pain, dark urine, and pruritus, whereas right upper quadrant pain was more frequent in patients with benign disease. Mean serum bilirubin was significantly higher in malignant versus benign cases (11.2 mg/dL vs 5.0 mg/dL). In multivariable analysis (complete cases, events = 22), age and serum bilirubin remained independent predictors of malignancy (age aOR 1.47 per 10 years, 95% CI 1.07 - 2.01; bilirubin aOR 2.03 per 5 mg/dL, 95% CI 1.86 - 2.45). Metastasis showed a strong trend but did not reach significance. Gold mining exposure was significantly associated with malignancy in univariate analysis but lost significance when undergoing multivariable regression testing. Smoking and sex were not significant. Conclusion: In this hospital series from Dongola, over half of obstructive jaundice presentations were due to malignancy, with hepatocellular carcinoma and pancreatic head carcinoma being the most common. High bilirubin levels and older age were independent predictors of malignancy. Residence near gold mining areas was associated with malignancy in descriptive analyses but did not remain significant after adjustment; this finding is hypothesis-generating and requires environmental and epidemiologic follow-up.