Hyperbilirubinemia: a new diagnostic marker for appendicular perforation

Authors

  • Ramaswami Y. B. Department of General Surgery, Mysore Medical College and Research Institute, Mysuru, India http://orcid.org/0000-0002-1174-5708
  • Prakash H. S. Department of General Surgery, Mysore Medical College and Research Institute, Mysuru, India
  • Raghavendra Prabhu T. C. Department of General Surgery, Mysore Medical College and Research Institute, Mysuru, India
  • Faiyaz Abdul Jabbar Department of General Surgery, Mysore Medical College and Research Institute, Mysuru, India

DOI:

https://doi.org/10.18203/2349-2902.isj20173880

Keywords:

Acute Appendicitis, Appendiceal perforation, Hyperbilirubinemia, Liver function test, Serum bilirubin

Abstract

Background: Appendicitis is one of the commonest causes of abdominal pain requiring emergency surgery. Diagnosing acute appendicitis clinically still remains a common surgical problem as the clinical signs and symptoms of other abdominal pathologic conditions mimic the diagnosis of acute appendicitis. Delay in diagnosis and surgery for this condition may lead to various complications like perforation, abdominal abscess etc. By knowing perforation prior to the exploration, we can manage the condition very effectively in terms explaining the prognosis of disease, morbidity of surgery, wound infection, and requirement of emergent nature of surgery. Aim of the study is to determine of role of hyperbilirubinemia as a new diagnostic marker to predict gangrenous/perforated appendicitis.

Methods: It’s a retrospective study was conducted in the department of surgery, MMCRI, Mysore during the period of January 2015 to December 2015 total of 100 patients with clinical as well as ultrasonographic diagnosis of acute appendicitis or appendiceal perforation were made. The serum bilirubin test was carried out in all the patients pre-operatively.

Results: In the study, the total 100 patients enrolled for the study, hyperbilirubinemia (> 1.2 mg/dL) in present study was found in 47 patients with 19 acute and 28 patients perforated appendicitis of all the 100 patients while 53 patients had normal bilirubin levels (≤ 1.2 mg/dL) 51 patients acute and 2 patients perforated appendix.

Conclusions: Total serum bilirubin appears to be a new promising laboratory marker for diagnosing appendicular perforation. The patients with clinical signs and symptoms of appendicitis and with hyperbilirubinemia without elevation of liver enzymes should be identified as having a higher probability of appendicular perforation, suggesting total serum bilirubin levels have a predictive potential for the diagnosis of appendicular perforation.

Author Biography

Ramaswami Y. B., Department of General Surgery, Mysore Medical College and Research Institute, Mysuru, India

GENERAL SURGERY

References

Townsend CM, Daniel BR, Mark EB, Mattox, KL. Sabiston Text Book of Surgery, 18th ed, Philadelphia: Saunders, an Imprint of Elsevier; 2008.

Brunicardi F, Andersen D, Billiar T, Dunn D, Hunter J, Matthews J, Pollock RE. Schwartz’s Brunicardi Principles of Surgery. 9th ed. McGraw Hill; 2010.

Williams NS, Bull strode CJK, O'Connell PR. Bailey and Love’s Short Practice of Surgery, 25th Edition.

Khan S. The diagnostic value of hyperbilirubinemia and total leucocyte count in the evaluation of acute appendicitis. J Clin Diag Res. 2009;3:1647-52.

Emmanuel A, Murchan P, Wilson I, Balfe P. The value of hyperbilirubinemia in the diagnosis of acute appendicitis. Ann R Coll Surg Engl. 2011;93:213-7.

Estrada JJ, Petrosyan M, Barnhart J, Tao M, Sohn H, Towfigh S, et al. Hyperbilirubinemia in appendicitis: a predictor of perforation. J Gastrointestinal Surg. 2007;11:714-8.

Karakas SP, Guelfguat M, Leonidas JC, Springer S, Singh SP. Acute appendicitis in children: comparison of clinical diagnosis with ultrasound and CT imaging. Pediatr Radiol. 2000;30:94-8.

Hoffmann J, Rasmussen OO. Aids in the diagnosis of acute appendicitis. Br J Surg. 1989;76:774-9.

Incesu L, Coskun A, Selcuk MB, Akan H, Sozubir S, Bernay F. Acute appendicitis: MR imaging and sonographic correlation. Am J Roentgenol. 1997;168:316-8.

Larsson PG, Henriksson G, Olsson M, Boris J, Stroberg P, Tronstad SE, et al. Laparoscopy reduces unnecessary appendicectomies and improves diagnosis in fertile women. A randomized study. Surg Endosc. 2001;15:200-2.

Lamparelli MJ, Hoque HM, Pogson CJ, Ball AB. A prospective evaluation of the combined use of the modified Alvarado score with selective laparoscopy in adult females in the management of suspected appendicitis. Ann R Coll Surg Engl. 2000;82:192-5.

Bruwer F, Coetzer M, Warren BL. Laparoscopic versus open surgical exploration in premenopausal women with suspected acute appendicitis. Afr J Surg. 2003;41:82-5.

Johnson AM. Sepsis and jaundice. Pediatrics. 1993;91:10-8.

Miller DJ, Keeton DJ, Webber BL, Pathol FF, Saunders SJ. Jaundice in severe bacterial infection. Gastroenterology. 1976;71:94-7.

Whitehead MW, Hainsworth I, Kingham JG. The causes of obvious jaundice in South West Wales: perceptions versus reality. Gut. 2001;48:409-41.

Chand N, Sanyal A J. Sepsis induced cholestasis. Hepatol. 2007;45(1):230-41.

Downloads

Published

2017-08-24

Issue

Section

Original Research Articles