Hyperbilirubinemia as a diagnostic marker for acute appendicitis

Sagar Ramesh Ambre, Shahaji Chavan


Background: Appendicitis is one of the commonest cause of abdominal pain requiring emergency surgery. Different clinical signs and symptoms always mimic the diagnosis of acute appendicitis with number of causes leading to pain in right iliac fossa, especially in females. Accurate diagnosis can be aided by additional tests. A delay in diagnosis can lead to appendiceal perforation with increased morbidity, and an appendectomy as soon as the condition is suspected, may increase the number of unnecessary appendicectomies. Objective of present study was to evaluate the role of hyperbilirubinemia as a diagnostic marker for Acute Appendicitis.

Methods: This is a prospective study of 100 patients carried out at Dr. D.Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune from May 2015 to September 2017. Patients presenting to surgical OPD with pain in Right iliac fossa will be evaluated. Those with a clinical diagnosis of acute appendicitis will be included in the study.

Results: Acute appendicitis is one of the most common emergencies and appendicectomy is one of the most frequently done abdominal operations. Clinical diagnosis using time tested clinical signs is effective in diagnosing appendicitis. However, bilirubin supports diagnosis and hence avoids chances of error in diagnosis. The investigation Bilirubin alone is not sufficient to accurately diagnose acute appendicitis, however the clinical findings, ALVARADO SCORE when combined can predict appendicitis. There is significant difference in total bilirubin in acute and probable cases of appendicitis but it can be used to differentiate both of them. In present study Mean bilirubin for acute appendicitis was 1.23mg/dl and probable cases of appendicitis was 0.84mg/dl, with SD for acute appendicitis was 0.598 and probable cases of appendicitis was 0.486. In our study bilirubin provide the highest diagnostic accuracy for acute appendicitis case. Normal inflammatory markers cannot exclude appendicitis, which remains a clinical diagnosis. The presence of history of pain and or signs of peritoneal inflammation which help you in diagnosing acute appendicitis.

Conclusions: Hyperbilirubinemia can be a diagnostic marker for acute appendicitis.


Acute appendicitis, Hyperbilirubinemia, TLC

Full Text:



Chaudhary P, Kumar A, Saxena H, Biswal UC. Hyperbilirubinemia as a predictor of gangrenous/perforated appendicitis: a prospective study. Ann Gastroenterol. 2013;26(4):325-31.

Scher KS, Coli JA. The continuing challenge of perforating appendicitis. Surg Gynacol Obstet. 1980;150:535-8.

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

Khan S. Evaluation of hyperbilirubinemia in acute inflammation of appendix: a prospective study of 45 cases. Kathmandu University Med J. 2006;4(3):287-9.

Estrada JJ, Petrosyan M, Barhart J. Hyperbilirubinemia in appendicitis: a new predictor of perforation. J Gastrointest Surg. 2007;11:714-8.

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

Pearl RH, Hale DA ,Molloy M, Schutt DC, Jaques DP. Paediatric appendectomy. J Paediatr Surg. 1995;30:173-8.

Flum DR, Koepsell T. The clinical and economic correlates of misdiagnosed appendicitis: nationwide analysis. Arch Surg. 2002;137:799-804.

Anderson RE. Meta-analysis of the clinical and laboratory diagnosis of appendicitis, Br J Surg. 2004;91:28- 37.

Khan S. Elevated serum bilirubin in acute appendicitis: a new diagnostic tool. Kathmandu Univ Med J. 2008;6:161-5.

Estrada JI, Petrosyan M, Barnhart J. Hyperbilirubinemia in appendicitis: a new predictor of perforation. J Gastrointest Surg. 2007;11:714-8.

Sengupta A, Bax G, Paterson- Brown S. White cell count and C-reactive protein measurement in patients with possible appendicitis. Ann R Coll surg Engl. 2009;91:113-5.

Vaughan-Shaw PG, Rees JR, Bell E, Hamdan M, Platt T. Normal inflammatory marks in appendicitis: evidence from two independent cohort Studied, JRSM Short Rep. 2011;2:43.

Wu HP, Huang CY, Chang YJ, Chou CC, Lin CY. Use of changes over time in serum inflammatory parameters in patients with equivocal appendicitis. Surg. 2006;139:789-96.

Miller DF, Irvine RW. Jaundice in acute appendicitis. Lancet. 1969;1:321-3.

Chand N, Sanyal AJ. Sepsis-induced cholestasis . Hepatol. 2007;45:230-41.

Bolder U, Ton-Nu HT, Schteingart CD. Hepatocyte transport of bile acids and organic anions in endotoxemic rats: impaired uptake and secretion. Gastroenterology. 1997;112:214-25.

Zuhoor K A1-gaithy. Clinical value of total white blood cells and neutrophil counts in patients with suspected appendicitis: retrospective study. World J Emerg Surg. 2012;7:32.

Sand M, Becharz FG, Holland- Letz T, Sand D, Mehnert G, Mann B. Diagnostic value of hyperbilirubinemia as a predictive factor for appendiceal perforation in acute appendicitis. Ann J Surg. 2009;198:193-8.

Noh H, Chang SJ, Han A. The diagnostic value of preoperative laboratory markers in children with complicated appendicitis. J Korean Surg Soc. 2012;83:237-41.

Patel D, Shah NJ, Patel B, Parikh M, Patel D, Dalal C. Evaluation of hyperbilirubinemia as a diagnostic marker for acute appendicitis and its role in the prediction of complicated appendicitis. Int J Res Med. 2014;3(3):28-33.

Ghimire P, Thapa P, Yogi N. Role of serum bilirubin as a marker of acute gangrenous appendicitis. NJMS. 2012;1(2):89-92.

Hong YR, Chung CW, Kim JW, Kwon C, Ahn DH, Kwon SW et al. Hyperbilirubinemia is a significant indicator for the severity of Acute Appendicitis. J Korean Soc Coloproctol. 2012;28(5):247-52.