Abstract
Background: Elevation in serum bilirubin was reported recently, but the importance of the raised total bilirubin has not been stressed in acute appendicitis and appendicular perforation. The aim of the study was to establish the role of hyperbilirubinemia as a new diagnostic tool to predict gangrenous/perforated appendicitis. Subjects and Methods: This was a prospective observational study, which was conducted at the Gujarat Adani Institute of Medical Science, Bhuj, Kutch, Gujarat, India. A total of 100 patients clinically diagnosed as appendicitis from August 2018 to August 2019 at Gujarat Adani Institute of Medical Science, Bhuj, Kutch, Gujarat, India. Patients were clinically evaluated by detailed history, routine examination on initial contact with patients and the routine investigations as per surgery and anesthesia requirements with inclusion of serum total bilirubin. Based on histopathological examination patients will be categorized as positive (acute appendicitis with perforation and/or gangrene) and negative (acute appendicitis without perforation or gangrene). Results: Out of 100 patients, 20 were managed conservatively (mass formation) and was called for interval appendectomy after 6 weeks. In acute catarrhal appendicitis group 47 patients showed normal total bilirubin levels, whereas 8 patients showed increase in levels of total bilirubin. In gangrenous appendicitis group all 10 patients showed elevated serum total bilirubin levels In perforated appendicitis group consisted of 15, 11 patients showed elevated serum bilirubin levels and 4 patients showed normal total bilirubin levels. Conclusion: Serum bilirubin is easily available test and cheap and can be estimated from the sample of blood drawn for routine blood investigations.
Highlights
Acute appendicitis is the most common cause of “acute surgical abdomen”. [1,2] Appendicectomy is the emergency abdominal operation most frequently performed and is often the first major procedure performed by a surgeon in training
Elevation in serum bilirubin was reported recently, but the importance of the raised total bilirubin has not been stressed in acute appendicitis and appendicular perforation
Total of 100 patients were admitted with diagnosis of acute appendicitis
Summary
Acute appendicitis is the most common cause of “acute surgical abdomen”. [1,2] Appendicectomy is the emergency abdominal operation most frequently performed and is often the first major procedure performed by a surgeon in training. [3] Delay in diagnosis and surgery for this condition may lead to various complications like perforation, abdominal abscess, urinary retention, small bowel obstruction and peritonitis causing an increase in morbidity and even mortality of the patients. [4,5] Delay in diagnosis of acute appendicitis leads to perforation and peritonitis with increased mortality. Elevation in serum bilirubin was reported recently, but the importance of the raised total bilirubin has not been stressed in acute appendicitis and appendicular perforation. A total of 100 patients clinically diagnosed as appendicitis from August 2018 to August 2019 at Gujarat Adani Institute of Medical Science, Bhuj, Kutch, Gujarat, India. Conclusion: Serum bilirubin is available test and cheap and can be estimated from the sample of blood drawn for routine blood investigations
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