Evaluation of Hyperbilirubinemia as a New Diagnostic Tool for Acute Appendicitis and Also As a Predictor of Appendiceal Perforation

Abstract

Background and Objectives ABSTRACT Acute appendicitis is the most common cause of an ‘acute abdomen’ in young adults. Diagnosis of Appendicitis still remains a dilemma in spite of the advances in various laboratory and radiological investigations. The present study was undertaken to assess relationship between hyperbilirubinemia and acute appendicitis and to evaluate its credibility as a diagnostic marker for acute appendicitis and also, to see whether elevated bilirubin levels have a predictive potential for the diagnosis of appendiceal perforation. Methodology This one year cross sectional study was conducted in the Department of Surgery, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belgaum during the period of January 2010 to December 2010. A total of 100 patients with clinical diagnosis of acute appendicitis or appendiceal perforation were studied. The serum bilirubin and liver function tests were carried out in all the patients. Results In this study, female ( 55% ) outnumbered males ( 45% ) and overall mean age was 23.6 ± 6.6 years. Of the 100 patients, 86% were diagnosed as acute appendicitis while 14% were diagnosed with appendiceal perforation. In patients with acute appendicitis, 80.23% had elevated bilirubin levels while 19.76% had normal bilirubin levels. Among patients with appendiceal perforation, 85.71% had elevated bilirubin levels while 14.28% had normal bilirubin levels. The IV Sensitivity and Specificity of serum bilirubin as a marker in predicting acute appendicitis and appendiceal perforation was 80.23% and 14.28% respectively with positive predicative value and negative predicative value of 85.18% and 10.5% respectively ( Odds ratio - 0.67) . Conclusion and interpretation Serum bilirubin levels appears to be a promising new laboratory marker for diagnosing acute appendicitis and also promises to have a predictive potential for the diagnosis of appendiceal perforation. Clinical sings and symptoms of appendicitis with hyperbilirubinemia three times the normal range is suggestive of higher probability of appendiceal perforation.