Appendicular Perforation Research Articles

HYPERBILIRUBINEMIA: A NEW DIAGNOSTIC MARKER FOR ACUTE APPENDICITIS AND ITS PART IN PREDICTING APPENDICULAR PERFORATION

Introduction:Acuteappendicitis is the commonest cause of Acute Surgical abdomen.Appendicectomy is the most frequently performed urgent abdominal operation and is often the first major procedure performed by a surgeon in training. Aims&Objectives:The objectives of the study were-To study the relationship between hyperbilirubinemia and acute appendicitis and to evaluate its credibility as a diagnostic marker for acute appendicitis. Materials&Methods:The study was conducted in the Department of General Surgery, HKEs Basaveshwar Teaching and General Hospital, kalaburagi attached to MahadevappaRampure Medical College, kalaburagi during the period of August 2022 to August 2023. A one year cross sectional study. Results:A total of 100 patients with clinical diagnosis of acute appendicitis or appendicular perforation admitted in the Department of General surgery, HKEs Basaveshwar Teaching & General Hospital, kalaburagi attached to MahadevappaRampure Medical College, kalaburagi were studied. Discussion:Acute appendicitis is the most common cause of acute abdomen in young adults. Appendicectomy is the most frequently performed urgent abdominal operation and is often the first major procedure performed by a surgeon in training.PPAbout 8% of people in Westerncountries have appendicitis at some time in their lifetime. Conclusion: The present study suggests-Serum bilirubin levels appears to be a promising new laboratory marker for diagnosing acute appendicitis, however diagnosis of appendicitis remains essentially still - clinical. Its level come out tobe a credible aid in diagnosis of acute appendicitis and would be helpful investigation in decision making.

The Present Scenario and Management Strategies of Pediatric Appendicitis

ABSTRACT Background and Aims: Despite contemporary discussion on the clinical presentation, imaging studies, indications of appendicectomy, and the best available approach, a diagnostic delay due to atypical presentations of appendicitis in preschool children is the current main cause of morbidity or mortality. Our aim is to reevaluate the present scenario of pediatric appendicitis and management strategies in our institution. Materials and Methods: The study was conducted with hospital records of 128 patients (below the age of 12 years) with appendicitis, who were managed (surgically or conservatively) in our institute during the last five years. Basic demographic data, presenting symptoms, radiological findings, mode of intervention, records of perioperative hospital care, and outcome were cumulated and inspected. Results: Among 128 cases, 37 (28.9%) had complications at presentation. Complicated appendicitis was more consistent with younger and higher C-reactive protein (CRP) at presentation. For 48 patients (37.5%), laparoscopic surgery was used; open surgery was performed in the other cases. Both open and laparoscopic surgeries had a similar rate of postoperative complications. Compared to laparoscopy, the open approach sometimes required longer hospital stays (97 hours vs 64 hours). Patients with appendicular perforation or abscess had 1.37- and 1.33-fold higher chance of requiring to stay in the hospital for more than 72 hours, respectively. There were found to be 3.83 and 8.33 times higher odds for the same patients to be readmitted within 28 days of surgery due to complications. Conclusion: Appendicular perforation or abscess occurs in every fourth child. A raised CRP at admission highly predicted the complicated appendicitis. Complicated appendicitis consistently increases hospital stay and readmission rates. Postoperative complication rates are more or less the same with either open or laparoscopy except for the duration of the hospital stay (more in open surgery).

Predictors of Morbidity and Mortality of Gastrointestinal Perforation in Children

Background: Gastrointestinal perforation is a common surgical problem in paediatric surgical ward in our country. It carries a high morbidity and mortality in children. The predictors of postoperative morbidity and mortality are still not well established. Objectives: The objective of this study was to identify the predictors of morbidity and mortality following surgery for gastrointestinal perforation in children. Methods: This was a single centre cross sectional type of descriptive observational study carried out in the Department of Paediatric Surgery, Mymensingh Medical College Hospital with 16-month duration from 1st January, 2017 to April 30, 2018, in children aged from 2-12 years. Predictors related to postoperative morbidity and mortality were investigated. Results: A total of 40 patients were selected for this study with mean age of 8.92±2.61 years. Male: female was 1.5:1. Analysis indicated that factors associated with postoperative morbidity and mortality were low BMI, poor nutritional status, low serum total protein and albumin, delay in seeking treatment and contaminated peritoneal collection. Appendicular perforation was the highest number perforation in 23(57.5%) patients. Ileal perforation was the second highest number 8(20%). Appendectomy was the highest surgical procedure 21(52.5%), followed by resection-anastomosis and wound excision & repair 3(7.5%) each. Serum total protein and albumin were below normal limit among 15(37.5%) and 35(87.5%) patients respectively. 13(32.5%) patients received treatment 72 hours after onset of symptom and 18(45%) patients undergone operation within 24-48 hours of admission. Postoperative complications developed in 30 patients. Among them SSI were in 20(66.66%), SIRS in 9(30%) and leakage of repair in 1(3.33%) patient. Mortality rate was 5%. Conclusion: Poor nutritional status, low total serum protein and albumin, delay in initiation of treatment, and contaminated peritoneal fluid are the predictors of morbidity and mortality of gastrointestinal perforation in children.

Utility of the derived neutrophil-to-lymphocyte ratio as a predictor of complicated appendicitis in pediatrics.

Between 16-40% of patients present with complicated appendicitis at the time of diagnosis, making early suspicion of appendicular perforation key for initiating timely treatment and reducing morbidity and mortality. This study evaluates the accuracy of the derived neutrophil-to-lymphocyte ratio (dNLR) as a predictor of complicated appendicitis. A diagnostic study was conducted, including patients aged 0-15 years who underwent appendectomy at a pediatric hospital between 2021-2022 (Reg. 2023/390894).

Correlational study of Hyperbilirubinemia as a diagnostic predictor for perforation in acute appendicitis

Background: Appendicitis is an acute and life-threatening situation if not treated promptly encountered in surgery practice. Even today, most cases of appendicitis are diagnosed by clinical findings and imaging. Scanty information is available to diagnose the perforation of the appendix using serological tests; hence, an attempt is made. The present study aimed to find out the correlation of hyperbilirubinemia as a diagnostic predictor for perforation in acute appendicitis patients. Methods: This prospective observational study was conducted among patients diagnosed with acute appendicitis attending OPD of the general surgery department of Narayana Medical College Hospital. The duration of the study is between January 2023 and December 2023. A total of 400 patients with a diagnosis of either acute appendicitis or perforation were recruited into the study, and they collected blood samples for estimation of hyperbilirubinemia. Results: In the study population of 400 patients, 72 cases were diagnosed as appendicular perforation, and 328 patients had acute appendicitis. The cut-off value of hyperbilirubinemia was taken as serum bilirubin >1.0 mg/dl. Out of 72 cases of appendicular perforations, 64 patients have hyperbilirubinemia (89%), while in the acute appendicitis patients group, 82 of 328 patients have elevated serum bilirubin (25%). The observed mean values of serum bilirubin in the two groups were 1.74 and 0.89, and the difference in the standard error of the mean value of the two groups is statistically significant at a P-value of <0.001. Conclusions: Patients who presented with acute appendicitis symptoms and had serum bilirubin values >1.0 mg/dl had a higher probability of appendicular perforation. Hence, measuring serum bilirubin can be considered an additional diagnostic tool to existing clinical diagnosis and radiological evaluation for more precision in diagnosis.

Diagnostic Efficacy Study Comparing Tzanakis Scoring System With Alvarado Scoring System in Effective Diagnosis of Acute Appendicitis.

Objective Among the common causes of abdominal emergencies, acute appendicitis ranks at the top, particularly in the young population. While negative appendectomy is not uncommon, the risk of appendicular perforation is substantial if the diagnosis is missed or delayed. This study evaluated the diagnostic efficacy of the Tzanakis scoring system for acute appendicitis, comparing it with the Alvarado scoring system, considering the histopathological finding as the gold standard. Materials and methods This prospective observational study, conducted in the General Surgery department in a tertiary care hospital in India, included clinically diagnosed acute appendicitis cases posted for open or laparoscopic appendicectomy. Results The mean age for the 60 participants included in the study was30.97±13.44, and the median was 24.5 yrs. The sensitivity ofultrasonography (USG)in diagnosing histopathological positive acute appendicitis was 89%, and the specificity was 50%. The sensitivity, specificity, positive, and negative predictive values of the Tzanakis score were 87%, 50%, 96%, and 22%, respectively, and those of the Alvarado score were 54%, 75%, 96%, and 10%, respectively. Conclusion The receiver operator characteristic (ROC) curve for the Alvarado and Tzanakis scores showed that the area under the curve (AUC) was greater for the Tzanakis scoring system (0.670) than for the Alvarado scoring system (0.598). Differences between the AUCs were not statistically significant. Although the Tzanakis scoring system is more sensitive than the Alvarado scoring system in diagnosing acute appendicitis, studies with larger samples are needed to show the superiority of this scoring system over the Alvarado scoring system.

ANALYSIS OF EMERGENCY CASES DONE BY DEPARTMENT OF GENERAL SURGERY OF GIMS KALABURGI, KARNATAKA, INDIA

Aims and objectives: 1. To know to the most common emergency cases operated. 2. Most common time of the day when the cases get operated 3. To know if Laparoscopic surgeries are being done as emergency procedures. Method: This is the prospective statistical analysis of the emergency cases operated in the GIMS, Kalaburgi from Oct 2022 to Oct 2023. The emergency OT cases done in our institute are collected and tabulated into Age of the patient, Diagnosis, type of surgery done, surgery done under what unit and time of the surgery and results are derived. All general surgical emergencies are included in the study and cases from the surgical super speciality emergency OTs are excluded from the study. Results: After tabulating, total cases operated on emergency basis were 698. Age groups most commonly presented were from 21-30 yrs(23%) followed by 31-40yrs(18%) and then 41-50yrs (14%) making 55% of all the cases. Most common procedure done was appendicectomy(Open)(159 cases)for acute appendicitis, appendicular perforation and appendicular abscess. Even Laparoscopic appendicetomy was also done in 10 cases, followed by debridments (149 cases) Incicion and drainage of abscess (136 cases) and then explorative laparotomy (80 cases) for multiple causes including Intestinal perforation, intestinal obstruction, Hemoperitoneum, GB perforation, volvulus, spleenectomy etc. 42 cases underwent orchidectomy, and 38 cases for amputations(above and below knee). 23 obstructed inguinal hernia cases were also operated. 313 cases were operated in the time slot C (6PM to 12AM) and followed by slot B (12PM to 6PM).. Conclusion: By our study we conclude that most common emergency cases operated in our institute is Appendectomy in the Time slot between 6 PM to 12 AM. In emergency condition laparoscopic procedures can also be done and the patient can be treated accordingly.

Appendicular Perforation in Pregnancy

In this case study, a third-trimester primigravida faced the rare challenge of a perforated appendix followed by successful perinatal outcome. Despite inconclusive imaging results from ultrasound and MRI, clinical progression guided the diagnosis. Timely intervention via emergency laparotomy, involving obstetric and gastro-surgical teams, averted further complications, ensuring a favorable outcome for both mother and baby. The complexities of diagnosing appendicitis during pregnancy, particularly when perforated, were emphasized. This instance underscored the pivotal role of a multidisciplinary approach, meticulous surgical planning, and attentive postoperative care, showcasing how prompt intervention and holistic management are paramount in navigating such intricate scenarios during pregnancy.

Association Between Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) Scoring and Pathological Severity of Acute Appendicitis: A Cross-Sectional Study.

Background and objectives Appendicitis is a frequent cause of abdominal pain. Because of the limited availability of imaging services in many medical centers and an urge to reduce the substantial number of unnecessary appendectomies, several clinical diagnostic tools have been constructed.A novel diagnostic tool, referred to as the Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) score, has been created to assist in identifying acute appendicitis (AA) in Asian nations. The study aimed to assess the correlation between RIPASA scores and the severity of appendicitis as determined by pathological examination. Materials and methods The study was a prospective observational investigation undertaken in the Department of General Surgery at Muslim education society (MES) Medical College Perinthalmanna over12 months. The study included all patients who had been diagnosed with AA and underwent appendectomy, provided they satisfied both the inclusion and exclusion criteria. An analysis was conducted on a convenience sample of 225 individuals using a prestructured proforma. The RIPASA scores were estimated before their surgery, taking into account their age, gender, symptoms, physical examination findings, and laboratory findings. These scores were subsequently contrasted withthe histopathological results obtained after the appendectomy. The individuals were categorized into three groups according to their RIPASA scores. The lower-score category, scores between 4 and 7. The intermediate-score category consists of scores ranging from 7.5 to 11.5, while the higher-score category includes scores of 12 and above. These scores are correlated with the histopathology report (HPR) to determine the presence of appendicitis, perforated appendix, appendicular abscess, or the absence of pathology observed. Results The study population comprised of 137 (60.9%) males and 88 (39.1%) females. Among these, 177 individuals (78.7%) were younger than 40 years, while 48 individuals (21.3%) were older than 40 years. Out of 225 cases, 146 cases were AA (64.9%), 27 (12%) appendicular abscess cases, and 41 (18.2%) appendicular perforation cases. The normal appendix was noted in 11 out of 225 cases in the low-score group. The association between the histopathological report and RIPASA score was found to be statistically highly significant (p=0.000). In the low-score group, there were 14 cases of appendicitis (53.8%), one case of appendicular abscess (3.8%), a total of 11 cases without pathology observed (42.3%), and no reported instances of appendicular perforation. In the intermediate-score category, there were 121 cases of appendicitis (89.6%), 12 cases of appendicular abscess (8.9%), 2 cases of appendicular perforation (1.5%), and no reported cases in the non-pathology category. Among the high-score category, there were 11 cases of appendicitis (17.2%), 14 cases of appendicular abscess (21.9%), 39 cases of appendicular perforation (60.9%), and no reported instances of negative appendectomy. Conclusion The study has shown that the RIPASA scoring system had a high diagnostic efficacy in identifying AA. This scoring system is an effective, dependable, cost-effective, noninvasive, reproducible, and safe diagnostic technique that does not require additional expenses or concerns.

The Study of Accuracy of Alvarado Score, CRP, Bilirubin Level and Mean Platelet Volume in the Diagnosis of Acute Appendicitis in a Tertiary Care Centre

Acute appendicitis is one of the common surgical emergencies and when it progresses to appendicular perforation, morbidity and mortality becomes much higher. Nearly 6% of the population is expected to have appendicitis in their lifetime. Though absolute diagnosis is only possible at operation and histopathological examination of the specimen, many scoring systems are available for the diagnosis of acute appendicitis. Among them Alvarado scoring system is an important one which is based on history, clinical examinations and few laboratory tests. Recent studies have shown the association of hyperbilirubinemia with acute appendicitis and appendicular perforation. Many reports have investigated the value of raised C reactive protein (CRP) and reduced mean platelet volume (MPV) in improving the diagnosis of acute appendicitis. The objective of our study was to evaluate the accuracy of Alvarado scoring system and CRP as a preoperative diagnostic tool in acute appendicitis and to evaluate whether hyperbilirubinemia and reduced MPV has a predictive potential for its diagnosis. A total of one hundred one patients coming to our emergency in a study period of one year were included. It was observed that the sensitivity, specificity, positive predictive value of Alvarado score was 82.7%, 70% and 96%, CRP level- 96.5%, 63.6%, 95.4%, total bilirubin level- 96.4%, 19%, 60.91%, MPV level- 95.7%, 16%, 51.72% respectively and the P value was clinically significant for Alvarado score, CRP level, total bilirubin level but not for MPV. We conclude that Alvarado score, raised total bilirubin level and CRP level are very effective in the diagnosis of acute appendicitis in both men and women but some other diagnostic modality may be necessary to ascertain the diagnosis in females to rule out pelvic pathology and to reduce negative appendicectomy rate.

To Determine that in Cases of Acute Appendicitis and Appendicular Perforation, Appendicular Base around 2 cm Remains Healthy

To Determine that in Cases of Acute Appendicitis and Appendicular Perforation, Appendicular Base around 2 cm Remains Healthy

Study of Appendicitis in Adult Population from Multiple Centres

Appendicular disease is considered one of the major medical problems in adult population. Acute or chronic Appendicitis usually presents an emergency in terms of both diagnostic urgency and therapeutic intervention. Delay in diagnosis further delays treatment,, which leads to emergency complications like Appendicular Perforation, Appendicular Abscess etc

Hypoganglionosis and Isolated Crohn’s Disease of the Terminal Ileum Presenting with Perforation Mimicking Appendicular Mass in a 72-Year-Old Asian Lady

A very unusual and interesting case of a 72-year-old Indian female with a background of chronic constipation since early infancy presented in emergency critical condition with acute perforative peritonitis and right lower quadrant fullness, guarding and tenderness. Laboratory studies showed high inflammatory markers and provisional diagnosis of walled off appendicular perforation was made. Radiographs and multi scanner computed tomography (MSCT) was found to have pneumoperitoneum secondary to the terminal ileal stricture with perforation. The patient underwent emergency exploratory laparotomy following initial resuscitation, resection and anastomosis of the ileal stricture, peritoneal toilet and extramucosal biopsies of rectosigmoid colon were performed. Histopathology confirmed isolated Crohn’s disease of terminal ileum with stricture and associated hypoganglionosis. Subsequent colonoscopy and biopsies showed no active Crohn’s disease but had nonspecific colitis of the left colon due to associated hypoganglionosis. The postoperative period was uneventful. The patient is doing well at follow up with conservative management of the hypoganglionosis with laxatives, dietary changes, life style modifications and dietary supplements.

A STUDY OF CLINICOPATHOLOGICAL PROFILE IN PATIENTS OF APPENDICULAR PERFORATION

Introduction: Appendicular perforation is one of the most common surgical emergencies. The diagnosis of appendicular perforation is based on clinical history, examination combined with investigation. Hb, total leukocyte count (TLC), and neutrophil USG CT help in confirming the diagnosis. Methods: A prospective study was conducted on patient coming with appendicular perforation, at a tertiary care center. Included subject underwent a through physical and clinical evaluation. Data were collected in performa and statistical analysis was done by applying the appropriate test. Results: Among 100 cases of operated appendectomy, great number of patients belonged to 11–20 years (40%) with male predominance (72%). Among all, 90% were diagnosed as histopathological examination positive (appendicular perforation). Sixty-nine percent (69%) patients were C-reactive protein (CRP) positive. Increased TLC in 70% of patients and raised neutrophilia in 54% of patients was observed. Out of 100 patients, 86% were USG positive and retrocecal appendix was the most common position. Tenderness at RIF was the most common sign present (100%). Rovsing’s sign was present in 25% cases while 15% cases were noted with obturator test. Majority of them (70%) had score of >7 and were diagnosed as modified Alvarado-positive cases. Conclusion: In our study, the combination of CRP, TLC, and neutrophil count has PPV of 100% which signifies their greater diagnostic accuracy in early diagnosis of acute appendicitis while the NPV after combining this test is 100% which signifies negative appendectomy can be decreased, if appendectomy is avoided in cases where TLC, CRP, and NC are normal.

EVALUATION, MANAGEMENT AND OUTCOME OF GASTROINTESTINALPERFORATIONS

Background: GIT perforation in an emergency is the third most frequent reason for explorative laparotomy.The occurrence of perforated peptic ulcers has decreased with thedevelopment of proton pump inhibitors. The methods for identifying and treating stomach and colon-rectal perforations have significantly changed with the development of laparoscopy and endoscopy Methods: All patients admitted and treated with perforation secondary to Hollow viscous perforation in surgical wards admitted during the period of JAN 2020 to JULY 2022 at Maharaja s institute of medical sciences, Vizianagaram Patients with Hollow viscus perforation admitted will be evaluated and the diagnosis will be made with history, clinical features and X-Ray Abdomen erect posture to support the diagnosis. Each case will be studied as per the proforma developed specifically for this study. Follow-up assessments will be done at first and third month during the postoperative period. Results: All the 30 cases weremanaged surgically with emergency laparotomy under General Anaesthesia.Out of 30 cases, 13 were appendicular perforations, 14 were acid pepticperforations in gastroduodenal region with single case of malignant gastricperforation, 1 idiopathic colonic perforation and 1 typhoid ileal perforation werenoted. Conclusion: Most common age of presentation is 3rd and 5th decade with male preponderance.Gastroduodenal perforation was the commonest cause of gastrointestinalPerforation followed by appendicular perforation. Peptic ulcer disease is most common etiology of GI perforation followed by appendicularperforation.

Surgical Management of a Strangulated Amyand’s Hernia in an Emergency Situation: A Practical Approach

Amyand’s hernia is a rare condition characterized by the presence of the appendix within an inguinal hernia. Although rarely seen, strangulated Amyand’s hernia is a surgical emergency requiring immediate management to avoid potentially serious complications. This condition, named after the French surgeon Claudius Amyand [1], is estimated to affect around 1% of inguinal hernia cases, with a prevalence of appendicular inflammation of only 0.1% [2]. It is more common in children, due to the permeability of the vaginal process [3]. In such situations, a practical approach involving immediate surgical exploration is warranted. Prompt treatment is essential to avoid serious complications, such as appendicular perforation or peritonitis. Surgical expertise, careful clinical assessment and patient-centered decision-making are essential for the successful management of these emergency cases. In conclusion, strangulated Amyand’s hernia is a rare condition that requires prompt surgical management. In emergency situations, early surgical exploration is recommended to avoid potential complications. This clinical observation illustrates the importance of practical decision-making in the management of such emergency cases, and highlights the need for a multidisciplinary approach involving surgical expertise and thorough clinical evaluation.

Efficacy of ultrasound-guided TAP block for postoperative pain relief in abdominal surgeries: A prospective, randomized controlled trial

: Transversus abdominis plane (TAP) block has emerged as a safe, reliable, and efficient technique to provide post-operative analgesia for a range of abdominal procedures and has been shown to minimize the usage of opioids in the perioperative period. This paper compares the overall efficacy and safety of TAP block for postoperative analgesia in abdominal surgeries, by two techniques (blind v/s USG). Eighty patients, ASA grade I-II, 18-60 years age group, posted for abdominal surgery like appendicectomy, appendicular perforation, umbilical, paraumbilical, incisional and ventral hernia repair, hysterectomy and exploratory laparotomy under GA. They were divided into two groups to undergo blind or USG-guided TAP block. At the end of the procedure, before the reversal, both groups received a TAP block with Inj. Bupivacaine 0.25% 20cc on each side in supine position. Patients were followed up for 24 hours, and pain scores were measured using a visual analogue scale. Inj. Diclofenac was given as rescue analgesic and Inj. Tramadol was used for breakthrough pain. Total analgesic requirement for 24 hours and complications if any, were noted.: VAS score was found to be significantly lower in USG- guided group at various time intervals till 12 hours (2.05 ± 0.75 vs 2.98 ± 1.03) in the USG-guided group as compared to the blind group (p<0.05). Time to first rescue analgesic was significantly prolonged in USG- the guided group being 19.68 ± 4.90 hours than the blind technique of 13.48 ± 6.86 hours (p <0.001). The number of rescue analgesics required in the USG-guided group was significantly lower than the blind technique (p<0.05).: USG-guided group had significantly less pain scores postoperatively and a reduced number of analgesic requirements. This resulted in fewer opioid-mediated side effects. TAP block can serve as a part of multimodal analgesia with enhanced recovery after abdominal surgery. The USG-guided approach helped in achieving near perfect block which is evident by pain scores and reduced analgesics required.

437 Appedicular Endometriosis – a Rare Intra-Operative Finding

Abstract Endometriosis is a known gynaecological condition in young women of reproductive age group. It presents with many different symptom complexes, most common presentation being pain abdomen especially during menstruation. Pelvis is the most common site for endometrial deposits. Gastrointestinal endometriosis is rare, appendicular endometriosis is rarer. There have been only a few case reports of endometriosis causing appendicitis. We came across a case of perforation peritonitis in a young girl with a background history of endometriosis. Patient presented with sign and symptoms of acute appendicitis and on USS was found to have inflamed appendix. During diagnostic laparoscopy she was found to have gangrenous perforated appendix and a hard nodule, which on histopathology revealed endometriosis. Another important fact revealed on histopathology was bleeding into the endometrial tissue. This patient underwent laparoscopic right hemicolectomy. Postoperative recovery was uneventful. Patient was discharged from the hospital on 5th postoperative day. We did literature research to find out that there have been only two cases reported in the literature of appendicular perforation caused by endometriosis.

Assessment of Hyperbilirubinemia in Acute Appendicitis

Introduction: Acute appendicitis is the most common cause of ‘acute abdomen’ in young adults. Appendicectomy is the most common surgery performed by a surgeon.However, sometime diagnosis is difficult to make in such case either the diagnosis is missed or patients with normal appendix are operated which lead to increase in morbidity and mortality. The aim of this study was to assess the relationship between hyperbilirubinemia and acute appendicitis and to see whether elevated bilirubin levels have a predictive potential for the diagnosis of appendicular perforation. Methods: This prospective study was carried out in Department of Surgery of National Medical College and Teaching Hospital. A total of 85 patients were included in this study. Data analysis was done using SPSS (Statistical Package for social sciences), version 26. Results: In this study, mean age was 28.86 year. Males (68.23%) outnumbered females (31.76%). Of the 85 patients, 62 patients were diagnosed as simple appendicitis while 23 patients were diagnosed with appendicular perforation. Out of 23 patients of appendicular perforation, 19 patients (82.60%) had raised bilirubin levels. The sensitivity, specificity, positive predicative value and negative predicative value of serum bilirubin as a marker in predicting acute appendicitis and appendicular perforation was 82.60%, 88.70%, 73.07%, 93.22% respectively. Conclusion: Serum bilirubin level appear to be a new laboratory marker in helping to diagnose a case of acute appendicitis.

Clinical Profile and Management of Perforation Peritonitis in a Tertiary Care Centre, Kerala, India

Peritonitis, an inflammation of the peritoneum and peritoneal cavity, is often brought on by a localised or systemic infection. Primary and secondary peritonitis are the two types of peritonitis. Once the clinical diagnosis of peritonitis is made, rapid institution of both physiologic support and aggressive anti-infective therapy are imperative. The objective was to study the frequency of perforation peritonitis in relation to various parameters ,and to study the post-operative complications and mortality. Cross-sectional study was conducted during the time period of 1 year. Findings were noted intra-operatively, patients were followed up until discharge or death. It was found that males were more affected than females, and majority was in the 21-35 years age group. Most common perforation was appendicular perforation followed by gastric and small intestine perforation. Diagnosis is made clinically and confirmed by presence of free gas under diaphragm. Mortality was 10% and the most common post-operative complication was wound infection.