Role of serum bilirubin in predicting the severity of acute appendicitis

Authors

  • Sandeep Y. Chinnapur Department of General Surgery, RRMCH, Bengaluru, Karnataka, India
  • Naveen Kumar S. Department of General Surgery, RRMCH, Bengaluru, Karnataka, India
  • Hanumanthaiah K. S. Department of General Surgery, RRMCH, Bengaluru, Karnataka, India

DOI:

https://doi.org/10.18203/2349-2902.isj20195404

Keywords:

Perforated appendicitis, Gangrenous appendicitis, Total bilirubin, Appendicectomy

Abstract

Background: The aim of the study was to establish the role of hyperbilirubinemia as a new diagnostic tool to predict gangrenous/perforated appendicitis.

Methods: A prospective study carried for 9 months (March 2018 to November 2018) at Rajarajeswari Medical College and Hospital. All patients admitted with clinical diagnosis of acute appendicitis and posted for surgery were included in the study. Serum total bilirubin results will be compared with Rajarajeswari Medical College and Hospitals laboratory reference values. These cases will be operated and clinical diagnosis will be confirmed per-operatively and post-operatively by histopathological examination. Final histopathological examination will be considered as a gold standard for diagnosing and categorizing patients as having normal appendix, acute appendicitis and acute appendicitis with perforation and/or gangrene. Based on histopathological examination patients will be categorized as positive (acute appendicitis with perforation and/or gangrene) and negative (acute appendicitis without perforation or gangrene).

Results: Sensitivity of serum bilirubin in case of perforated/gangrenous appendicitis was found to be 90%. Specificity of serum bilirubin was found in case of perforated/gangrenous appendicitis was found to be 90.47%. Positive predictive value and negative predicting value of serum bilirubin in perforated/gangrenous appendicitis was found to be 81.8% and 95% respectively with p value of 0.003.

Conclusions:Serum total bilirubin is an easily available and cheap and can be estimated from the same blood sample withdrawn for routine investigations, if added to routine investigations, then diagnosis of complicated appendicitis can be made with fair degree of accuracy. 

 

References

Cheekuri SK, Mohanty A, Ganesh T, Kannan R, Smile R. Hyperbilirubinemia as a predictor of the severity of acute appendicitis - an observational study. Int Surg J. 2017;4:1341-4.

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

D’Souza N. Bilirubin; a diagnostic marker for appendicitis. Int J Surg. 2013;11(10):1114-7.

Hong YR, Chung CW, Kim JW, Kwon CI, Ahn DH, Kwon SW, et al. Hyperbilirubinemia Is a Significant Indicator for the Severity of Acute Appendicitis. Coloproctol. 2012;28(5):247-52.

Giordano S, Pääkkönen M, Salminen P, Grönroos JM. Elevated serum bilirubin in assessing the likelihood of perforation in acute appendicitis: a diagnostic meta-analysis. Int J Surg. 2013;11(11):795-800.

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

Khan S. Elevated serum bilirubin in acute appendicitis: A new diagnostic tool. Kathmandu Univ Med J. 2008;6(2):161-5.

Chambers AC, Bismohun SL, Davies H, White P, Patil AV. Predictive value of abnormally raised serum bilirubin in acute appendicitis: A cohort study. Int J Surg. 2015;13:207-10.

Vaziri M, Pazouki A, Tamannaie Z, Maghsoudloo F, Pishgahroudsari M, Chaichian S. Comparison of pre-operative bilirubin level in simple appendicitis and perforated appendicitis. Med J Islam Repub Iran. 2013;27(3):109-12.

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Published

2019-11-26

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Section

Original Research Articles