Abstract
Background: The rate of misdiagnosis of appendicitis has remained constant, despite the advance in diagnostic modalities. So, the search for a reliable marker is necessary. The aim of this study was to determine the value of hyperbilirubinemia as a marker for acute appendicitis. Patients and Methods: This prospective study was carried out during the period from April 2014 till April 2017 and included 369 patients presented with right iliac fossa pain diagnosed clinically as acute appendicitis and submitted to appendectomy (open or laparoscopic). Demographic data, data of clinical examination, radiological and laboratory investigations (specifically, complete blood count (CBC), C- reactive protein (CRP) and total serum bilirubin) were collected. Then appendectomy was done, the removed appendices were sent for histopathological examination. Patients were divided into three groups: group (I) histopathologically normal appendix, group (II) simple appendicitis and group (III) Complicated appendicitis. The data of the three groups were analyzed and compared. Results: This study included 369 patiens, 195 (52.8%) are males. Mean age was 22.6 ±7.22 years. Open appendectomy was performed in 306 (91.2%) patients and laparoscopic in 63 (8.8%). Histopathological examination revealed normal appendix in 69 (18.6%) patients, simple appendicitis in 240 (65.0%) and complicated appendicitis in 60 (16.2%). The serum total bilirubin had a higher specificity (87%) compared with white blood cells (WBC) (70%) and CRP (65%), but a lower sensitivity (28% vs. 66% and 58%, respectively) for acute appendicitis versus normal appendix group and a higher specificity (80%) than both WBC (35%) and CRP (45%), but a lower sensitivity than WBC and CRP (60% vs. 70% and 70% respectively) for complicated appendicitis versus simple appendicitis. Conclusion: Hyperbilirubinemia is a significant predictor in diagnosis of acute appendicitis in cases of right iliac fossa pain. It is also a significant predictor of complication (perforation and gangrene) in cases of acute appendicitis.
Highlights
Acute appendicitis is one of the most common surgical conditions with the life time risk for appendectomy is estimated to be 12% for males and 23% for females. appendectomy is a minor procedure without significant consequences, when diagnosed early
This study was carried out at the general surgery department, Tanta university hospital, Tanta, Egypt, during the period from April 2014 till April 2017 and included 369 patients presented with right iliac fossa pain diagnosed clinically as acute appendicitis and submitted to appendectomy
The mean value of white blood cells (WBC) count was significantly higher in the group of complicated appendicitis than the group of simple appendicitis and the group of normal appendices (14.01±4.15, 12.02±3.95, 11.21±3.52 respectively), P value = 0.025
Summary
Acute appendicitis is one of the most common surgical conditions with the life time risk for appendectomy is estimated to be 12% for males and 23% for females. appendectomy is a minor procedure without significant consequences, when diagnosed early. Despite the remarkable advancement in diagnostic modalities like high resolution computed tomography (CT), still the rate of misdiagnosis is remaining about 15% [2] This urges the search for more consistent markers that can differentiate between complicated & uncomplicated acute appendicitis. Patients and Methods: This prospective study was carried out during the period from April 2014 till April 2017 and included 369 patients presented with right iliac fossa pain diagnosed clinically as acute appendicitis and submitted to appendectomy (open or laparoscopic). The serum total bilirubin had a higher specificity (87%) compared with white blood cells (WBC) (70%) and CRP (65%), but a lower sensitivity (28% vs 66% and 58%, respectively) for acute appendicitis versus normal appendix group and a higher specificity (80%) than both WBC (35%) and CRP (45%), but a lower sensitivity than WBC and CRP (60% vs 70% and 70% respectively) for complicated appendicitis versus simple appendicitis. It is a significant predictor of complication (perforation and gangrene) in cases of acute appendicitis
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