BACKGROUND/OBJECTIVE: Systematic data are limited on the etiology and prognosis of unselected patients with obstructive jaundice (OJ). We aimed to review the clinical features, etiology, and prognosis of patients with OJ. METHODS: All adult patients with bilirubin ≥ 5.85 mg/dL (100 μmol/L) at a university hospital in Sweden in 2003–2004 were identified. Medical records from patients with OJ were reviewed. RESULTS: Seven hundred and forty‐nine patients were identified, of whom 241 (32%) had OJ (median age 71 years, 129 women). No one was lost to follow‐up. The biliary obstruction of 154 patients (64%) was a result of a malignancy: 69 patients (46%) had pancreatic cancer, 44 (29%) had cholangiocarcinoma (CC), 5 (3%) had papilla vateri cancers, and 36 patients (23%) had other malignancies. Of the 87 patients with a benign obstruction, 57 (65%) had choledocholithiasis, 7 (8%) had biliary strictures, 6% had PSC, and the obstruction of 16 patients (20.7%) had other causes. A total of 115 of the 242 patients (48%) had abdominal pain associated with jaundice, whereas 52% had painless jaundice. Thirty‐four percent of patients with a malignant obstruction had abdominal pain versus 71% of patients with a benign obstruction (P < .05). At the end of follow‐up, only 5% (8 patients) with a malignant obstruction were alive versus 78% with a benign obstruction. CONCLUSIONS: Obstructive jaundice was the cause of the severe jaundice of one third of patients. Most cases of OJ were a result of a malignancy, which carried a very poor prognosis, with a 2‐year mortality rate of 95%. Journal of Hospital Medicine 2008;3:117–123. © 2008 Society of Hospital Medicine.