A study to determine the value of pre operative hyperbilirubinemia as a predictor of complicated appendicitis
DOI:
https://doi.org/10.18203/2349-2902.isj20203489Keywords:
Acute appendicitis, Gangrenous appendix, Hyperbilirubinemia, Perforated appendixAbstract
Background: Acute appendicitis is a common acute abdominal condition that all surgeons confront. The early detection of patients who could go in for complication is critical so that appropriate treatment can be initiated to reduce mortality. There is no pre-operative investigation which accurately point out the patients who are going to develop severe disease. Hence this prospective study was done to identify whether preoperative bilirubin level can predict the severity of the disease.
Methods: The study was conducted in the Department of General Surgery, Sree Gokulam Medical College and Research Foundation, Venjaramoodu, Trivandrum on 100 consecutive patients who were clinically diagnosed as acute appendicitis. These patients were evaluated with Alvarado score. In addition, preoperative bilirubin level and liver enzymes were estimated. Ultrasound abdomen was done preoperatively routinely. After surgery histopathology was studied. The parameters which showed statistically significant results for predicting complications were analyzed.
Results: In this prospective study on 100 consecutive patients, acute appendicitis was found more commonly in males, 57 (57%) cases than in females, 43 (43%) cases. Among the cases 56 were acute appendicitis, 13 perforated, 11 gangrenous and 20 suppurative appendicitis. In our study, there was significant correlation of preoperative hyperbilirubinemia with complications of appendicitis.
Conclusions: Patients with appendicitis with elevated bilirubin levels have more chance for complications like perforation, gangrene and suppuration.
References
Khan AQ, Patil A, Pawar P. Role of hyperbilirubinemia as a diagnostic predictor of appendicular perforation. Int J Sci Res. 2014;3(12):2012-5.
Smink DS, Soybel DI. Appendix and appendectomy. In: Maingot’s Abdominal Operations. 11th ed. New York McGraw Hill; 2007: 589-612.
Von Titte SN, McCabe CJ, Ottinger LW. Delayed appendectomy for appendicitis: causes and consequences. Am J Emerg Med. 1996;14(7):620-2.
Temple CL, Huchcroft SA, Temple WJ. The natural history of appendicitis in adults. A prospective study. Ann Surg. 1995;221(3):278.
Grönroos JM, Grönroos P. A fertile-aged woman with right lower abdominal pain but unelevated leukocyte count and C-reactive protein. Langenbeck’s Arch Surg. 1999;384(5):437-40.
Puylaert JBCM, Rutgers PH, Lalisang RI, de Vries BC, van der Werf SDJ, Dörr JPJ, et al. A prospective study of ultrasonography in the diagnosis of appendicitis. N Engl J Med. 1987;317(11):666-9.
Alvarado A. A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med. 1986;15(5):557-64.
Kalan M, Talbot D, Cunliffe WJ, Rich AJ. Evaluation of the modified Alvarado score in the diagnosis of acute appendicitis: a prospective study. Ann R Coll Surg Engl. 1994;76(6):418.
Berg RD, Garlington AW. Translocation of Escherichia coli from the gastrointestinal tract to the mesenteric lymph nodes in gnotobiotic mice receiving Escherichia coli vaccines before colonization. Infect Immun. 1980;30(3):894-8.
Juric I, Primorac D, Zagar Z, Biocić M, Pavić S, Furlan D, et al. Frequency of portal and systemic bacteremia in acute appendicitis. Pediatr Int. 2001;43(2):152-6.
Whitehead MW, Hainsworth I, Kingham JG. The causes of obvious jaundice in South West Wales: perceptions versus reality. Gut. 2001;48(3):409-13.
Chaudhary P, Kumar A, Saxena N, Biswal UC. Hyperbilirubinemia as a predictor of gangrenous/ perforated appendicitis: a prospective study. Ann Gastroenterol Q Publ Hell Soc Gastroenterol. 2013;26(4):325.
Atahan K, Üreyen O, Aslan E, Deniz M, Çökmez A, Gür S, et al. Preoperative diagnostic role of hyperbilirubinaemia as a marker of appendix perforation. J Int Med Res. 2011;39(2):609-18.
D’Souza N, Karim D, Sunthareswaran R. Bilirubin; a diagnostic marker for appendicitis. Int J Surg. 2013;11(10):1114-7.
Sand M, Bechara FG, 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.
Estrada JJ, Petrosyan M, Barnhart J, Tao M, Sohn H, Towfigh S, et al. Hyperbilirubinemia in appendicitis: a new predictor of perforation. J Gastrointest Surg. 2007;11(6):714-8.
Silva FR, da Rosa MI, Silva BR, Simon C, Alexandre MC, Medeiros LR, et al. Hyperbilirubinaemia alone cannot distinguish a perforation in acute appendicitis. ANZ J Surg. 2016 ;86(4):255-9.
Emmanuel A, Murchan P, Wilson I, Balfe P. The value of hyperbilirubinaemia in the diagnosis of acute appendicitis. Ann R Coll Surg Engl. 2011;93(3):213-7.
