A Comparative Study of Hyperbilirubinemia in Predicting Appendicitis and its Complications

Abstract

Background: Acute appendicitis is the most common general surgical emergency in young adults. Diagnosis of Appendicitis still remains a dilemma in spite of the advances in various laboratory and radiological investigations. Importance of hyperbilirubinemia or elevated Serum Bilirubin and its association in acute appendicitis and its complication as been postulated recently. The present study was undertaken to assess relationship between hyperbilirubinemia in predicting appendicitis and its complication. Methods: The present study was conducted in the Department of Surgery, SIMS & RH ,Tumkur during the period of August 2019 to August 2020. A total of 100 patients with clinical diagnosis of acute appendicitis or Appendicular perforation were studied. The serum bilirubin and LFTs were carried out in all the patients. Results: In this study, males (56%) outnumbered females (44%). Of the 100 patients, 91% were diagnosed as acute appendicitis clinically while 9% were diagnosed with Appendicular perforation. Postoperatively 82% were confirmed as acute appendicitis while 18% were diagnosed with Appendicular perforation. Of 82 patients with acute appendicitis, 74.39% had raised bilirubin levels, while 25.6% had normal levels. 18 patients were diagnosed as Appendicular perforation, 15 patients (83.33%) had raised bilirubin levels, while the remaining 03 patients (16.66%) had normal levels. Conclusion: The Sensitivity and Specificity of serum bilirubin as a marker in predicting acute appendicitis and Appendicular perforation was 74.39% and 83.33% respectively.Serum bilirubin levels appears to be a promising new laboratory marker for diagnosing acute appendicitis, however diagnosis of appendicitis is essentially still - clinical. Patients with clinical signs and symptoms of appendicitis and with hyperbilirubinemia double the normal range (Raise in Direct Bilirubin being still higher) should be identified as having a higher probability of Appendicular perforation suggesting, serum bilirubin levels have a predictive potential for the diagnosis of Appendicular perforation.