A study on the role of raised serum bilirubin levels in acute appendicitis and its outcomes

Abhilash Madhavan, Lakshmana Raman


Background: Acute appenidictis is the most common general surgical emergency and early surgical intervention improves outcomes. Despite the increased use of ultrasonography, computed tomography and laparoscopy, the rate of misdiagnosis of appendicitis has remained constant (15.3%) as has the rate of appendicular perforation. Thus, elevated serum bilirubin level will help in the early and accurate diagnosis of acute appendicitis and if so does it have the predictive capacity to warn us about appendicular perforation.

Methods: In this study 100 patients were selected as per satisfaction of the inclusion criteria. This study was carried out at SRM medical college hospital between July 2017 to October 2018. All the data findings were recorded and were analysed.

Results: In this study 100 patients were selected on satisfying the inclusion criteria. The serum bilirubin levels were recorded for all these patients. Based on the study it was found out that the serum bilirubin levels was elevated in majority of the cases of acute appendicitis and markedly elevated in case of perforated appendicitis. Though the results were not statistically significant the study seems to be clinically significant.

Conclusions: Serum bilirubin level seems to be a reliable diagnostic marker for predicting acute appendicitis and perforated or gangrenous appendicitis.


Acute appendicitis, Perforated/gangrenous appendicitis, Serum bilirubin, Total counts

Full Text:



O' Connel PR. “The Vermiform Appendix”. In: Williams NS, Bulstrode CJK, O'Connell PR (Ed.). Bailey and Love's - Short practice of surgery. 25 ed. London: Arnold; 2008: 1204-1208.

Smink DS, Soybel DI. “Appendix and Appendectomy”. In: Zinner MJ, Stanely W (eds) Maingot‟s abdominal operations. 11th ed. Ashely: McGraw Hill; 2007: 589-612.

Rioux M. Sonographic detection of the normal and abnormal appendix. Am J Roentgenol. 1992; 158:773-8.

Alvarado A. A practical score for early diagnosis of acute appendicitis. Ann Emerg Med. 1986;15:557-64.

Maa J. The Appendix. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18thed. Philadelphia, Pa: Saunders Elsevier; 2008: 1333-1347.

Addiss DG, Shaffer N, Fowler BS, Tauxe RV. The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol. 1990;132(5):910-25.

Flum DR, Morris A, Koepsell T, Dellinger EP. Has misdiagnosis of appendicitis decreased over time? A population-based analysis. JAMA. 2001

Jaffe BM, Berger DH. The Appendix. In: Brunicardi F, Andersen D, Billiar T, Dunn D, Hunter J, Matthews J, et al. Schwartz's Principles of Surgery. 9thed.New York: McGraw Hill; 2009: 1073-1092.

Deutsch A, Shani N, Reiss R. Are some appendectomies unnecessary: and analysis of 319 white appendices. J R CollSurg Edinb. 1983;28:35-40.

Piper R, Kager E, Nasman P. Acute appendicitis a clinical study of 1018 cases of emergency appendicectomy. Acta Chir Scand. 1982;148:51-62.

Estrada JJ, Petrosyan M, Krumenacker J Jr, Huang S, Moh P. Hyperbilirubinemia in Appendicitis: A New Predicator of Perforation. J Gastrointestinal Surg. 2007;11:714–5.

Khan S. Evaluation of hyperbilirubinemia in acute inflammation of appendix: A prospective study of 45 cases. KUMJ. 2006;4(3)15:281-9.

Sand M, Bechara GF, Holland-Letz T, Sand D, Mehnert G, Mann B. Diagnostic value of Hyperbilirubinemia as a predictive factor for Appendiceal perforation in Acute Appendicitis. Am J Surg. 2009;198(2):193-8.