Abstract
Introduction: Acute appendicitis is the most common general surgical emergency and early surgical intervention improves outcomes. The diagnosis of appendicitis can be elusive, and a high index of suspicion is important in preventing serious complications from this disease. The present study was undertaken to assess relationship between hyperbilirubinemia and acute appendicitis to evaluate its credibility as a diagnostic marker for acute appendicitis. Material & methods: The case control study was carried out on 60 patients who were clinically diagnosed as having acute/perforated appendicitis and on 60 healthy volunteers from the community having no signs and symptoms of acute appendicitis. The evaluation of acute appendicitis was done by history taking ,clinical examination and investigations including CBC, Ultrasonography and confirmed by histopathological examination of appendicectomy specimen. For the final analysis various statistical methods like descriptive, crosstabs, chi-square test were applied using the SPSS (version 20.0). Results: Total serum bilirubin level was raised in 43 patients (71.7%) out of the total sample of 60 cases. Of these, 42(70%) cases were positive for appendicitis on HPE (True Positive), and 1(1.7%) was negative on HPE (false positive). Among the 17(28.3%) cases in whom serum bilirubin was not raised, in 3(5%) cases HPE was negative (True Negative), and in 14 (23.3%) cases HPE was positive (False Negative). In 60 healthy individuals mean serum bilirubin was 0.7±0.3 mg%. In 46 cases of histopathologically proved acute appendicitis (non-perforated) the mean serum bilirubin was 1.3±7mg% while in perforated group it was 2.5±1.1mg% (P value was significant i.e. <0.001). Conclusion: Serum bilirubin is an important adjunct in diagnosing the presence of gangrenous/perforated appendicitis. Our findings confirm that hyperbilirubinaemia has a high specificity for distinguishing acute appendicitis.
Highlights
Acute appendicitis is the most common general surgical emergency and early surgical intervention improves outcomes
In the continued absence of a 100% accurate test for appendicitis, any investigation that can contribute to its diagnosis is valuable.Diagnosis of acute appendicitis, clinically still holds a central place
A safe alternative seems to be appendectomy as soon as the condition is suspected, a strategy that increases the number of unnecessary appendectomies [4,5]
Summary
Acute appendicitis is the most common general surgical emergency and early surgical intervention improves outcomes. Material & methods: The case control study was carried out on 60 patients who were clinically diagnosed as having acute/perforated appendicitis and on 60 healthy volunteers from the community having no signs and symptoms of acute appendicitis. In 46 cases of histopathologically proved acute appendicitis (non-perforated) the mean serum bilirubin was 1.3±7mg% while in perforated group it was 2.5±1.1mg% 15], ultrasound imaging [16,17], computed tomography (CT) scan [18,19], scintigraphy [20], MRI [21], and laparoscopy [22,23,24] None of these methods stands alone as they all come in support of, and are secondary to a primary clinical assessment
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