Diagnostic value of serum hyperbilirubinemia in acute appendicitis and its complications

Authors

  • Farooq A. Mir Department of Surgery, Government Medical College Srinagar, Jammu and Kashmir India
  • Shaugfta Aara Department of Physiology, Government Medical College Srinagar, Jammu and Kashmir India
  • Masrat Jan Department of Anaesthesiology and Critical Care Medicine, Government Medical College Srinagar, Jammu and Kashmir India
  • Nisar A. Wani Department of Surgery, Government Medical College Srinagar, Jammu and Kashmir India

DOI:

https://doi.org/10.18203/2349-2902.isj20171626

Keywords:

Appendicitis, Complicated appendicitis, Serum bilirubin

Abstract

Background: To increase diagnostic accuracy and to decrease complication rates secondary to acute appendicitis, a variety of different approaches have been described, including predictive scoring systems. To prevent the catastrophic effects of perforated appendix, a surgeon needs diagnostic tools which may signal perforation of appendix at earliest, as a result of which the delay in the management of perforated appendix will not be witnessed. Keeping in view the above facts, the diagnostic value of serum bilirubin in acute appendicitis and its complications has been evaluated.

Methods: This prospective study was conducted on 100 patients who presented with clinical diagnosis of Acute Appendicitis. Role of serum bilirubin as a diagnostic tool in acute appendicitis and diagnostic value of hyperbilirubinemia as a predictive factor for appendiceal perforation was evaluated. . Estimation of serum bilirubin was done by Jendrassik and Gorf method using Hitachi – 912 automatic biochemistry analyzer. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of the investigations in the diagnosis of the acute appendicitis were calculated.

Results: Serum bilirubin levels had a sensitivity of 84.1% and specificity of 83.3% in the diagnosis of acute appendicitis. The mean bilirubin level of patients with gangrenous appendicitis (2.1±1.2mg/dl) was significantly higher than the mean bilirubin level of patients with simple acute appendicitis (1.5 ±0.6)   (p1=0.030 sig). A statistically significant difference was also observed in the mean bilirubin level of patients with perforated appendicitis (mean=2.9±1.6mg/dl) and mean bilirubin level of patients with simple acute appendicitis (p2=<0.0001 sig). However statistically non-significant difference was observed between the mean bilirubin level of patients with gangrenous and perforated appendicitis (p3=0.056 non- sig).

Conclusions:Pre-operative assessment of serum bilirubin not only helps in acute appendicitis but also serves as a predictive factor for appendiceal perforation.

 

Author Biographies

Farooq A. Mir, Department of Surgery, Government Medical College Srinagar, Jammu and Kashmir India

Government Medical College Srinagar Jammu and Kashmir India 190010

Shaugfta Aara, Department of Physiology, Government Medical College Srinagar, Jammu and Kashmir India

Department of Physiology, Government Medical College Srinagar, Jammu and Kashmir India

Masrat Jan, Department of Anaesthesiology and Critical Care Medicine, Government Medical College Srinagar, Jammu and Kashmir India

Department of Anaesthesiology and Critical Care Medicine, Government Medical College Srinagar, Jammu and Kashmir India

Nisar A. Wani, Department of Surgery, Government Medical College Srinagar, Jammu and Kashmir India

Department of Surgery, Government Medical College Srinagar, Jammu and Kashmir India.

References

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

Owings MF, Kozak LJ. Ambulatory and inpatient procedures in the United States, 1996. National Centre for Health Statistics 13, No. 139. Hyattsville Md: Department of Health and Human Services Centers for Disease Control and Prevention, National Centre for Health Statistics, 2004.

Temple CL, Huchcroft SA, Temple WJ. The national history of appendicitis in adults. A prospective study. Ann Surg. 1995;221:278-81.

Sand M, Bechara FG, Letz TH, 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.

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

Beg RB, Garlungton AW. Translocation of certain endogenous bacteria from the GI tract to mesenteric lymphnodes and other organs in Genobiotic mouse model. Infect Immunol. 1979;23:403-11.

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

Khan S. The diagnostic value of hyperbilirubinemia and total leucocyte count in the evaluation of acute appendicitis. J Clin Diagn Res. 2009;3(4):1647-52.

Pruekprasert P, Maipang T, Greater A, Apakupakul N, Kasuntigj P. Accuracy in diagnosis of acute appendicitis by comparing serum C-reactive protein measurements, Alvarado Score and clinical impression of surgeons. J Med Assoc Thai. 2004;87(3);296-303.

Kalan M, Rich AJ, Talbot D, Cunliffe WJ. Evaluation of the modified Alvarado score in the diagnosis of acute appendicitis: a prospective study. Ann R Coll Surg Engl. 1994;76:419.

Ashmawy IH, Halim TA, Bessa SS. Evaluation of combined graded compression ultrasonography with Alvarado Score in the diagnosis of acute appendicitis. Bull Alex Fac Med. 2006;42(1):29-34.

Denizbasi A, Unluer EE. The role of emergency medicine resident using the Alvarado score in the diagnosis of acute appendicitis in comparison with the general surgery resident. Eur J Em J Emerg Med. 2003;10:296-301.

Lau WY, Ho YC, Chu KW, Yeung C. Leucocyte count and neutrophil percentage in appendectomy for suspected appendicitis. NZ J Surg. 1989;59:395-8.

Nordback I, Harju E, Inflammation parameters in the diagnosis of acute appendicitis. Acta Chir Scand. 1988;154:43-8.

John H, Neff U, Kelemen M. Appendicitis diagnosis today. Clinical and ultrasonic deductions. World J Surg. 1993;17:243-9.

Shah NA, Islam M, Sabir IA, Mehreen T, Khan M. Diagnostic accuracy of clinical examination versus combination of abdominal ultrasound and Alvarado score, in patients with acute appendicitis. JPMI. 2008;22(1):41-6.

Smnk DS, Soybel DI. Appendix and Appendectomy. In: Maingots Abdominal operation. 11th ed. 2007;(21):589-611.

Athan K, Ureyen O, Aslan E, Deniz M. Preoperative diagnostic role of hyperbilirubinemia as a marker of appendix perforation. J Int Med Res. 2011;39:609-18.

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.

Downloads

Published

2017-04-22

Issue

Section

Original Research Articles