Background: Obstructive jaundice is a common health challenge in daily clinical practice caused by a heterogeneous group of benign and malignant conditions in or around extrahepatic bile ducts. This study aimed to investigate the causes of obstructive jaundice, analyze the age and sex distribution, and report the locations of obstruction. Methods: This was a retrospective study of electronic records of patients diagnosed with obstructive jaundice in the Hadhramout region in Yemen. Results: This study analyzed the data of 303 patients (mean age: 57 ± 17.99 years; range: 18–95 years); 60.40% (n = 183) were female, and 39.60% (n = 120) were male. The highest prevalence was found in middle-aged adults (n = 112, 36.96%), followed by the old (n = 101, 33.33%). Common bile duct (CBD) stones were the most common cause of obstructive jaundice (n = 175, 57.8%), followed by CBD stricture (n = 58, 19.1%), carcinoma of the head of the pancreas (n = 35, 11.6%), cholangiocarcinoma (n = 21, 6.9%), and external compression of the CBD (n = 2, 0.7%). CBD stones, cholangiocarcinoma, and ampulla of Vater masses were more prevalent in females (30.9%, 3.8%, and 2.2%, respectively) than in males (25.8%, 2.9%, and 1.7%, respectively). In contrast, CBD stricture and carcinoma of the pancreas were more frequent in males, occurring in 12.1% and 7.1% of male patients, respectively, compared to 7.9% and 4.9% in female patients. The primary obstruction site was the CBD (n = 254, 83.8%), followed by the head of the pancreas (n = 30, 9.9%), and the ampulla of Vater (n = 13, 4.3%). Conclusions: Obstructive jaundice predominantly affects middle-aged adults followed by the old-aged patients predominantly in females. The most common cause of obstructive jaundice was CBD stones, followed by CBD stricture, while carcinoma of the head of the pancreas was the most common malignant cause, followed by cholangiocarcinoma. Distal CBD is the most common anatomical location of obstructive jaundice.

This research investigated the unstudied impact, in 416 cases of stone-induced hydronephrosis detected radiographically in 369 patients, of stone size on the stone’s location in the urinary tract and on the hydronephrosis grade. Most (62.5%) of the hydronephrosis cases were Grade 2; 17.1%, Grade 3; 10.6%, Grade 4; and 9.9%, Grade 1. The mean size of the stones reported in the renal pelvis, pelviureteric junction (PUJ), upper ureter (UU), midureter (MU), lower ureter (LU), and vesicoureteral junction (VUJ) that caused hydronephrosis were 23.03 ± 8.97 mm, 15.56 ± 6.59 mm, 12.91 ± 6.02 mm, 11.05 ± 4.27 mm, 10.41 ± 4.80 mm, and 6.73 ± 3.28 mm, respectively. The mean size of Grade 1-causing stones was 16.63 mm; Grade 2, 11.49 mm; Grade 3, 15.69 mm; and Grade 4, 21.23 mm. The mean stone size significantly decreased from the renal pelvis, through the PUJ, UU, MU, and LU, and down to the VUJ and increased as the hydronephrosis grade increased from Grade 2 to Grade 4. In conclusion, large-size stones were predominantly located in the renal pelvis and PUJ, with few located in the lower ureter, and no large stones reached the VUJ. Small-size stones were mostly located in the VUJ, with only one stone in the PUJ, and no small-size stones were present in the renal pelvis. Large-size stones caused severe hydronephrosis, and small-size stones caused grade 2 hydronephrosis. Increases in stone size decreased its passage rate in the ureter and increased the chance of causing high-grade hydronephrosis. These results alert urologists to adopt faster therapeutic procedures for larger stone sizes to reduce renal damage caused by obstructive uropathy.

Perianal fistula, or anal fistula, is an abnormal granulomatous tract connecting the anal canal or rectum to the surrounding skin. It causes perianal pain and fistulous discharge, negatively impacting patients’ quality of life. The mechanism underlying fistula formation remains incompletely understood. Medical imaging is essential for accurate preoperative assessment of the shape, number and branching of fistulous tracts, identification of internal openings and Parks’ classification. This pictorial review provides an image-based overview of the key medical imaging concepts essential for the diagnosis of perianal fistulae and summarises the roles, advantages and limitations of the available imaging modalities for evaluating perianal fistulae. The current evidence on X-ray fistulography, computed tomography (CT) fistulography, transcutaneous ultrasonography (TCUS), endoanal ultrasonography (EAUS) and pelvic magnetic resonance imaging (MRI) was reviewed, emphasising on their diagnostic performance and clinical applications. Conventional X-ray fistulography has progressively been abandoned because it is invasive, is uncomfortable for patients, provides poor soft tissue contrast and inadequately visualises anal sphincters, complex fistulous tracts, secondary branches and abscesses. CT fistulography is useful for evaluating perianal abscesses and fistula when MRI and EAUS are unavailable. TCUS is widely available, non-invasive and radiation-free but is operator-dependent and has limited ability to evaluate high perianal fistulae. EAUS accurately evaluates fistulous tracts, can be performed at the bedside or intraoperatively and is reliable when MRI is contraindicated. However, EAUS is operator-dependent, is contraindicated in patients with severe anal stenosis or acute anal pain, and has a small field of view. Pelvic MRI is the gold standard, providing excellent visualisation of anal canal anatomy, superior soft tissue contrast, accurate mapping of fistulous tracts, localisation of internal openings, assessment of the involvement of anal sphincters and detection of secondary tracts, abscesses and associated complications. Consequently, MRI is a preferred imaging modality, which can guide treatment decisions and monitoring of treatment response.