Common Cause Of Acute Abdomen Research Articles

Çocukta Valentino Sendromu: Akut Apandisiti Taklit Eden Perfore Peptic Ülser

The most common cause of acute abdomen in children is appendicitis. However, in cases when the appendix is observed normally during surgery, other surgical causes should be considered. Rarely, in the differential diagnosis of right lower quadrant (RLQ) pain, gastric or duodenal ulcer perforation, defined as Valentino Syndrome, should be considered and evaluated for possible pathology. In this case report, we aimed to discuss a case of unusual gastric perforation that presented with symptoms and signs suggestive of appendicitis. Free air was not identified on plain abdominal x-ray, and also no specific finding was found on ultrasonography. The appendix was normal during surgery. There was plenty of serous fluid in the right lower quadrant. When fibrin was observed in upper quadrants, the incision was expanded and it turned out to be a gastric perforation and was repaired. In cases with peritonitis findings in the examination of the abdomen, even though the appendix is normal, it is very important to evaluate all intraabdominal organs in terms of other diagnoses.

Comparison of clinical accuracy v/s investigations in the diagnosis of acute appendicitis

Background: Now a day there is a trend to rely more on high-tech investigations rather than taking thorough history and clinical examination of the patients in the diagnosis of acute pain abdomen. Commonest cause of acute abdomen in the surgical practice is appendicitis. Delay in the diagnosis and treatment of acute appendicitis, leads to complications. Objective of this study was to evaluate the accuracy of clinical diagnosis versus sensitivity and specificity of ultrasound examination and histopathological examination of the resected specimen of appendix. This study also assesses the incidence of negative appendectomies in a medical college hospital of North Karnataka.Methods: This study included one hundred and fifty patients with history of pain abdomen where clinical diagnosis of acute appendicitis was made. The study period was of 18 months between February 2014 to July 2015. Routine blood investigations and abdominal ultrasonography were done in all cases. All ultrasound positive cases were subjected to surgery. Some ultrasound negative cases were also taken to surgery on the high suspicion of diagnosis of acute appendicitis depending upon thorough history taking and clinical examination. The diagnosis made depending on the ultrasound findings were compared with clinical findings, operative findings and histopathological examination reports.Results: Out of 150 patients, 104 were male and 46 were female. The common symptoms were pain in the RIF (100%) and anorexia (80%).The overall sensitivity and specificity of clinical diagnosis was 96.9% and 90.48% respectively. The same for ultrasound was 86.99% and 33.33% respectively. The present study shows negative appendectomy rate 6.66% in females and 7.33% in males.Conclusions: The diagnostic accuracy of ultrasound was 84.87% whereas clinical diagnosis was 96%. Thus, detailed history taking, and thorough clinical examination still holds good in the diagnosis of acute appendicitis and should be stressed in the clinical teaching.

Management Outcome of Small Intestinal Obstruction in Mizan Aman General Hospital, Ethiopia.

Background: Small Intestinal obstruction is defined as any hindrance to the passage of small intestinal contents. It is one of the most common causes of acute abdomen. If not treated on timely manner the outcome will be bad. The causes are varying from region to region, as well as from season to season. Knowing this variety helps us for appropriate management. Most of the time, it is difficult to differentiate these causes clinically. So it is important to know the commonest cause in our area. The objective of this research was to assess the causes and management outcome of small intestinal obstruction among patients admitted with acute abdomen in the hospital. Methods: A retrospective cross-sectional study design was conducted during a period between January 1, 2012 to December 30, 2014. Data was collected from patients’ medical record charts and operation registration book of patients admitted to surgical ward with the diagnosis of intestinal obstruction. All the cases found in the study period and who are eligible were included in the study. One hundred twenty six of patient charts were analyzed. Results: Over the course of three years there were 297 patients with intestinal obstruction Admitted to Mizan Aman General Hospital, From which 157 (53%) were small bowel obstruction. The male to female ratio was 2.15:1. The ages ranged from 2 years to 65 years with and a mean age of 28.45 years with standard division of 13.04years. The leading cause of obstruction was adhesion in 48 (47%) patients followed by small bowel volvulus in 34 (33, 3%). Hernia was third in 7 (6.9%). Bowel resection rate was at 40.2%. Length of stay ranged from 4 days-23 days with a mean of 9.39 days and standard division of 4.024 days. The commonest complication was wound infection (21.7%). Complication and Mortality rates were 37.3% and 9.52% respectively. Conclusion: Adhesion was the leading cause of obstruction followed by small bowel volvulus. There is a lower morbidity and mortality rates in our study which can be explained by improvement in post-operative care. There are few causes of obstruction caused by external hernia which means hernias are being repaired electively before causing obstruction. Early diagnosis, adequate preoperative resuscitation and proper post-operative care would help to reduce further the observed mortality. This could be achieved by increasing public awareness on clinical features of intestinal obstruction as well as by improving the knowledge of mid and lower level health professionals on the diagnosis, resuscitation and importance of early referral to higher center. Moreover, health facilities capable of handling patients with intestinal obstruction should be available within the reach of the community. External hernias should always be repaired before strangulation and obstruction.

Double Duodenal Perforation: A Case Report

Duodenal perforation is a common cause of acute abdomen which is complication of peptic ulcer disease. The pathogenesis is considered complex and involves imbalance between defensive mechanisms of intestinal mucosa and aggravating factors to which a person is exposed.

Evaluation of the diagnostic accuracy of Modified Alvarado scoring system in Comparison to Histopathological results in Acute appendicitis

Background: Acute appendicitis even today remains the commonest cause of acute abdomen needing surgical intervention. In developing countries the clinical diagnosis still poses a challenge to the surgeon and advanced radiological investigations are not cost effective while histopathological diagnosis remains the gold standard. The Modified Alvarado score augments the accuracy of diagnosis of appendicitis thus reducing the rate of negative appendicectomy.Methods: Patients admitted with clinical findings suggestive of Acute appendicitis were evaluated by applying Modified Alvarado scoring system.Those patients with Alvarado scores above 5 were subjected to appendicectomy.The Modified Alvarado score was correlated with that of histopathologial features of appendicectomy specimens.Results: The histopathological features of appendicitis was seen in 87.8% of the cases whose scores were more than 7 while negative appendicitis was seen in 38.1% whose scores were between 5-7.The sensitivity, specificity, positive predictive value and negative predictive value of Alvarado scores in our study were 87.80%, 38.01%, 73.50% and 61.50% respectively. Conclusions: The study concludes that the Modified Alvarado scoring system is more sensitive in diagnosing acute appendicitis with reference to the histopathological findings.DOI: 10.21276/APALM.1642

A rare case of small-bowel obstruction due to broad ligament herniation

Small-bowel obstruction is a common cause of acute abdomen throughout the world. Internal hernia as the cause of small-bowel obstruction is exceedingly rare and accounts for only about 1% of all acute obstructions. Of this, a very small fraction may occur through defects in the broad ligament, whether congenital or iatrogenic. The symptomatology is consistent with that of small-bowel obstruction due to any other cause rendering preoperative diagnosis extremely difficult. Most cases are recognized intraoperatively. The complications are dreaded, as bowel gangrene and perforation secondary to prolonged herniation are well documented. A high index of suspicion is, thus, needed. In this case report, we present a patient of jejunal loop herniation into broad ligament who presented with acute intestinal obstruction.

Acute intestinal obstruction: small intestine vs. large intestine: an analysis

Background: Bowel obstruction is one of the most common causes of acute abdomen and also a common surgical emergency.The causes of IO vary significantly depending on geographical location. The aim of this study was to identify the etiology, clinical presentation, management and outcomes of patients with acute mechanical IO presenting in Jodhpur, Rajasthan.Methods: A prospective study was conducted at Mahatma Gandhi Hospital and Mathura Das Mathur Hospital (associated with Dr. SN Medical College), Jodhpur, Rajasthan. 100 patients with acute intestinal obstruction were admitted and evaluated. Blood routine, X-Ray abdomen, USG abdomen and CECT (if required) were done. A pre-operative diagnosis was made. Intra-operative findings and Post-operative complications were noted and follow up was done till the patient was discharged from the hospital.Results: A total of 69 male and 31 female patients, presented with acute mechanical IO during the period of the study. Mean patient age was 48.5 years with peak incidence in those aged 31-45 years. The foremost signs and symptoms were abdominal distension (88%), obstipation (87%), abdominal pain (81%) and nausea/ vomiting (47%). Adhesions and bands (29%), hernia (13%), neoplasm (9%) and pseudo-obstruction (8%) were the leading causes of intestinal obstruction. The sensitivity of X-ray and USG in present study was 67% and 75% respectively. Most common complication associated was wound infection (17%) followed by paralytic ileus (7%) and respiratory tract infections (6%). Late presentation was associated with poor prognosis. 4 patients expired before surgery. Post-operative mortality was associated with 6 patients and was more common in cases which presented with gangrenous bowel.Conclusions: The most common causes of IO in this study were adhesions and bands, hernia, neoplasm and pseudo-obstruction. Presence of bowel gangrene was associated with higher morbidity and mortality.

Evaluation of hyperbilirubinemia as an innovative diagnostic marker for acute appendicitis and its role in the prediction of appendicular perforation

Background: Acute appendicitis is one of the most common causes of acute abdomen in surgical practice. Despite advances in the radiological and laboratory investigations, the diagnosis of appendicitis remains dilemma. The negative appendicectomy rate varies 15-50%, with up to 50% postoperative complications in these patients. Hence we conducted a study to assess the role of hyperbilirubinemia in diagnosing acute appendicitis and to foresee appendicular perforation.Methods: It was a prospective study conducted in the Department of General Surgery, M.R. Medical College, Gulbarga, Karnataka, India for 18 months duration from December 2010 to May 2012. Only histopathologically confirmed cases of acute appendicitis and/or appendicular perforation were included in the study. Demographic data, history and clinical findings were recorded on a predesigned proforma. Investigations included complete blood count, reticulocyte count, platelet count, peripheral smear, serum haptoglobulin, liver function tests, HbsAg, urine analysis (routine and microscopy).Results: The sensitivity and specificity of serum bilirubin as a marker in predicting acute appendicitis and appendicular perforation was 78.6% and 8.6% respectively. Similarly, the positive predictive value and negative predictive value for the same was 77.5% and 9.1% respectively. The Odds ratio was 0.344.Conclusions: Serum bilirubin level appears to be a promising new laboratory marker for diagnosing acute appendicitis and would be a decision-making investigation. Patients with clinical appendicitis and with hyperbilirubinemia are to be suspected of having a higher risk for appendicular perforation.

Clinical study and management of hollow viscus perforation of abdomen

Background: Gastrointestinal perforation is a common abdominal emergency having a high morbidity and mortality. Surgery plays an important role in the management of perforation. Gastrointestinal perforation is a common abdominal emergency having a high morbidity and mortality.Methods: 100 cases of hollow viscus perforation of the abdomen have been studied prospectively in detail during the period from May 2010 to July 2012. Cases were selected randomly from admissions in Government Mohankumaramangalam Medical College Hospital, Salem, Tamil Nadu, India. Clinical diagnosis of hollow viscus perforation confirmed by investigations or by laparotomy performed.Results: The results obtained in the present study were analysed: Among hollow viscus perforation duodenal ulcer perforation was common (52 out of 100 cases). Next being appendicular perforation. Age group of 20-40 years were affected mainly. Males are affected more than females. Signs and symptoms of acute abdomen like acute abdominal pain vomiting fever may present tachycardia, hypotension, abdominal tenderness guarding\rigidity with obliteration of liver dullness and absence of bowel sounds and absolute constipation were predominant signs.Conclusions: GI hollow viscus perforations cause significant morbidity and sometimes mortality. Hollow viscus perforation is the common cause of acute abdomen needing immediate effective surgical attention. A proper early diagnosis and adequate treatment can prevent complications. Surgical approach depends on the site, size, age of perforation and number of perforations.

Risk Factors for Complications in Acute Appendicitis among Paediatric Population

Appendicitis is one of the most common causes of acute abdomen in children. Patients who are diagnosed early and undergo an appendectomy before perforation have a good outcome. However, it is difficult to diagnose in young children because its clinical manifestations may be atypical. The aim of this study was to determine the risk factors for complications in acute appendicitis in paediatric population. We performed a cross sectional study on children (age ≤18 years) who underwent appendectomy for suspected appendicitis from January 2014 to December 2015. Medical records of patients who met inclusion criteria were reviewed. Preoperative, operative and post-operative data were analyzed. The main outcome measure was intraoperative confirmation of gangrenous orperforated appendicitis. Multivariate logistic regression analysis was performed, and the main predictors of interest were patient's age, duration of pain and total leucocyte count. Total 73 paediatric patients (46 males) with mean age 13±3.8 were studied. In multivariate logistic regression analysis, patients having pain duration more than 72 hours and patients with leucocyte count >15000/mm3 were more likely to have complicated appendicitis [(OR:14.6), (95% CI= 2.40 - 89.77), (P= 0.004)] and [(OR=16.38), (95% CI = 1.836-146), (P = 0.012)] respectively. However, the age of the patient is not independently associated with complicated appendicitis. Increase in total leucocyte count and duration of the presentation can be a good marker of complicated appendicitis.

A study of surgical profile of patients undergoing appendectomy

Background: The most common cause of acute abdomen in surgical is appendicitis. Among the surgeries of abdomen performed all over the world, appendectomy is the most common operation performed. Many studies have shown variations of age, gender in acute appendicitis as well as the seasonal variations in the occurrence of acute appendicitis, although the cause is not found yet. Objective was to study the surgical profile of patients undergoing appendectomy.Methods: A total of 302 patients who have undergone appendectomy were included in the present study which was hospital based cross sectional study. The study was carried out for two years at Osmania General Hospital, Hyderabad, India. Permission from Institutional Ethics Committee permission was obtained. From each and every patient included in the study, initially Informed individual consent was taken.Results: The incidence of appendicitis is much more in females i.e. 60% compared to only 40% in males. Appendicitis was most common in younger age groups of below 30 years of age. As the age increased the incidence of appendicitis decreased. From 83.2% at 30 or less than 30 of age it drastically dropped down to 15.9% in the age group of 30-49 years and in the age group of 50 and above, the incidence of appendicitis came down to less than one percentage. Only three cases were recorded above the age of 50 years.Conclusions: Present study revealed more rates in females. The disease was more common in younger age groups. The most common presenting symptom was abdominal pain. Presence of abdominal mass was absent in the present study.

Hyperbilirubinemia as a Significant Indicator in Diagnosis of Complicated Acute Appendicitis: A Prospective Study

Background: Acute appendicitis is the most common cause of acute abdomen in young adults. In recent years, studies emerged showing that elevated serum total bilirubin levels could indicate a complicated case of acute appendicitis. An elevated serum total bilirubin that is not explained by liver disease or biliary obstruction can be present in many patients of acute appendicitis. Patients and methods: This is a prospective interventional non-randomized non-controlled study conducted on 175 consecutive cases of acute appendicitis admitted to the emergency unit in the Department of General Surgery at Ain Shams University hospitals, Cairo, Egypt in the period from July 2014 to August 2016. Liver function tests were done as a part of the preoperative investigations. Clinical diagnosis was confirmed postoperatively by histopathological examination. Their clinical and investigative data were analyzed, The level of significance was set at P< 0.05. Results: Serum total bilirubin was found to be significantly elevated in cases of complicated acute appendicitis. Conclusion: Serum total bilirubin is a new important adjunct in the diagnosis of complicated acute appendicitis.

Stump appendicitis in a 2 year-old patient. Case report and literature review

La apendicitis del muñón es una causa poco común de abdomen agudo quirúrgico en niños, razón por la cual su diagnóstico no se sospecha con frecuencia. Este artículo reporta el caso de un paciente de dos años admitido en el servicio de urgencias por vómito, dolor abdominal y fiebre.Al ingreso, el paciente presentaba taquicardia, taquipnea, distensión abdominal y dolor difuso a la palpación del abdomen; los laboratorios evidenciaban leucocitosis, trombocitosis y elevación de la PCR. Inicialmente, se consideró obstrucción intestinal con base en antecedentes de peritonitis secundaria a una apendicitis perforada; sin embargo, debido al deterioro hemodinámico y al aumento del dolor abdominal, fue llevado a laparotomía exploratoria de urgencia.Durante el procedimiento se encontró peritonitis generalizada con apendicitis de la base, perforación intestinal, múltiples adherencias y, de forma incidental, un divertículo de Meckel. Se realizaron las intervenciones quirúrgicas correspondientes, y por su grave estado, fue hospitalizado en la unidad de cuidados intensivos (UCI), en donde recibió tratamiento con antibiótico de amplio espectro por 14 días y varios lavados peritoneales; por último, el paciente fue dado de alta satisfactoriamente.Aunque la apendicitis del muñón no es una causa frecuente de abdomen agudo, es necesario considerarla en aquellos pacientes con antecedentes de apendicitis y que ingresan por dolor abdominal, ya que la demora en el tratamiento se asocia con mayor morbilidad y aumento en los costos de atención.

Treatment of Appendicitis With Iliopsoas Abscess by Laparoscopic One-Step Surgery

Acute appendicitis is the most common cause of acute abdomen and on rare occasions can present atypically with a retroperitoneal abscess. In this report, we present a rare case of acute appendicitis combined with iliopsoas muscle abscess. A laparoscopic appendectomy and iliopsoas abscess drainage were performed by a one-step laparoscopic procedure that did not incur any intraoperative or postoperative complications. The results of this case demonstrate that the laparoscopic approach is feasible and effective for the treatment of appendicitis complicated by retroperitoneal abscess. J Curr Surg. 2017;7(1-2):23-25 doi: https://doi.org/10.14740/jcs313w

Outcome of Non-Traumatic Surgical Acute Abdomen in Nekemte Referral Hospital Southwest Ethiopia: A Retrospective Cross-Sectional Study

Background: Acute abdomen is an acute onset of abdominal disease entities that require immediate surgical intervention in most of the cases. The causes of non-traumatic surgical acute and their relative incidence varies in different populations. Objective: To determine the magnitude and the common causes as well presenting features and the outcome of non-traumatic surgical acute abdomen (In Nekemte Referral Hospital, Oromia region, Ethiopia). Methods: A retrospective cross sectional study was conducted using data available at Nekemte Referral Hospital from January 2011 to December 2013. We examined 295 records of the patients from the medical records. Data were collected using checklist based on registration books. The data were entered and analyzed using SPSS version 20.0 statistical package. The association between the independent and dependent variable was assessed by bivariate and multivariate regression analyses. A 95% CI and p-value of ≤0.05 were used to determine independent predictors of outcome of non-traumatic surgical acute abdomen. Results: Out of 295 patients, 230 were males and 65 were females. The age ranged from 6 months to 80 years with a mean age of 33.7 ± 18.6 years. Out of 295, 57.6% was rural and 46.4% were urban dwellers. The most common cause of acute abdomen was acute appendicitis 140(47.4%) followed by bowl obstruction 118(40.0%). Age, Residence, Duration of illness and length of hospital stays are independent predictors of management outcomes of non-Traumatic acute abdomen. Conclusion: Complications were more in cases from rural area due to delay at presentation and no operation facility and surgeons for solutions.

Role of Point of Care Ultrasound in the Diagnosis of Perforated Peptic Ulcer

Perforated peptic ulcer is a common cause of acute abdomen and intra-abdominal infection in the emergency departments. The diagnosis is usually made by typical history, diffuse abdominal tenderness, muscle guarding and confirmed by x-ray or computed tomography. Despite previous studies point out that ultrasound is superior to plain radiography to diagnose pneumoperitoneum, most emergency physicians are still not familiar with this application. We report a case presenting with diffuse abdominal pain and muscle guarding to the emergency department and the diagnosis of perforated peptic ulcer was made by point of care ultrasound and confirmed by computed tomography and surgery. Case report and literature review. A 75 year old woman presented with dull epigastric pain for one week and developed acute abdominal pain for half day Her vital signs were stable. Physical examination reveled diffuse abdominal tenderness and muscle guarding, especially over epigastrium. Ultrasound showed dirty ascites at Morrison’s pouch, right para-colic gutter and pelvic region, free air above surface of left lobe liver and a perforated hole at pre-pyloric region. Computed tomography and surgical finding confirmed the diagnosis. This case indicates that point of care ultrasound in emergency department can be use to diagnose intraperitoneal free fluid and air. It is also possible to diagnose perforated ulcer at prepyloric region. In addition to abdominal aortic aneurysm screening, we recommend routine use of point of care ultrasound to screen free fluid in dependent regions and free air in nondependent regions for patient presenting with acute abdominal pain in the emergency departments.

A prospective study of epidemiology and clinical presentation of non-traumatic acute abdomen cases in a tertiary care hospital of central India

Background:Acute Abdomen is a term used to encompass a spectrum of surgical, medical and gynecological conditions ranging from trivial to life threatening conditions, which require hospital admission, investigations and treatment. The purpose of this study was to identify the epidemiological pattern and to determine the spectrum of disease causing “non-traumatic acute abdomen in central India”.Methods: This is a prospective study of 98 patients of non-traumatic acute abdominal cases conducted in the Department of Surgery, Sri Aurobindo Medical College and PG Institute, Indore, Madhya Pradesh, India. In this study, preoperative detailed history and thorough physical examination was done for all acute abdominal emergencies, to arrive at pre-operative diagnosis.Results:Amongst the study of 98 patients, males have higher incidence of acute abdomen with the young age group (21-30 years) most commonly affected. Perforation peritonitis constituted the most common cause of acute abdomen (39.7%), followed by acute appendicitis (37.7%), followed by intestinal obstruction (14.2%).Conclusions: This study was conducted to evaluate the epidemiology, etiology and differential diagnosis of non-traumatic acute abdomen. At the end of the study, we had a better insight of the spectrum of the condition and we concluded that there is more scope for further work in the same field for better understanding of this topic.

INTESTINAL TUBERCULOSIS

Tuberculosis is one of the leading causes of morbidity and mortality, responsiblefor annual 7–10 million new cases and 6 per cent of deaths in developing countries. It caninvolve any part of abdomen but most common is intestinal tract in which it can present withwide variety of symptoms. Early diagnosis and appropriate management is challenging forclinicians. Objectives: To determine the modes of presentation of abdominal tuberculosisand effectiveness of surgical procedures in our setup. Study Design: A retrospective study.Setting: Surgical unit-I of Holy Family Hospital, Rawalpindi. Period: January 2014 to December2014. Materials and Methods: 50 patients with abdominal tuberculosis were included inthe study. Histopathology confirmed the diagnosis of abdominal tuberculosis. Age, gender,mode of presentation, evidence of co-existing tuberculosis, family history, drug history of antituberculoustreatment, laboratory and radiological investigations, treatment modalities andduration of hospital stay were recorded. Results: There were 28 female (56%) and 22 male(44%) patients with a mean age of 29± 10.23 years. 56% patients presented with subacuteintestinal obstruction, 16% with acute intestinal obstruction and 14% with peritonitis. All 50patients underwent laparotomy. Ileocecal mass with perforation (40%) was seen as the mostcommon per-operative finding. Limited right hemicolectomy with ileocolostomy (44%) wasperformed in most of the cases. Mean length of hospital stay was 10 ± 4.67 days. Conclusion:Abdominal tuberculosis is a common cause of acute abdomen especially intestinal obstructionin our setup, with a variable mode of presentation. Early diagnosis with appropriate surgicalmanagement and chemotherapy can prevent significant morbidity and mortality.

Surgeon's clinical valuation and accuracy of ultrasound in the diagnosis of acute appendicitis: A comparison with intraoperative evaluation. Five years experience

IntroductionAcute appendicitis is the most common cause of acute abdomen in adolescents, with an overall incidence of 7%. Two such tools are used to diagnose acute appendicitis: ultrasound and Computer Tomography imaging. End point of this study was to verify the accuracy of ultrasound imaging in the diagnosis of acute appendicitis with respect to intraoperative observations and the respective clinical and laboratory findings in young and in the elderly. MethodsWe considered all the appendectomies for acute appendicitis performed between 1 January 2010 and 1 January 2015. We evaluated clinical symptoms, laboratory findings, ultrasound findings, intraoperative signs, and anatomical and pathological findings. In the study we compared the ultrasound and intraoperative findings and then compared these with the respective clinical and laboratory data. ResultsIn a comparison of diagnostic accuracy, the difference between clinical and ultrasound examinations was not significant. The differences between the diagnostic accuracy of clinical and laboratory findings and between ultrasound and laboratory investigations were statistically significant. ConclusionWe defined white blood cells and C protein levels as non-diagnostic of the type of acute inflammation but rather as indicators of the severity of the inflammatory process.We also agree with the authors who proposed the incorporation of ultrasonography into routine practice in the diagnosis of acute appendicitis, but only and exclusively to support other diagnostic procedures and preferably within emergency departments. A thorough clinical examination of patients with suspected acute appendicitis is still the best diagnostic procedure available to us.

Evaluation of Hyperbilirubinemia as a New Diagnostic Marker for Acute Appendicitis and its Role in the Prediction of Appendicular Perforation

INTRODUCTION: The most common cause of acute abdomen is Appendicitis. The diagnosis of acute appendicitis is based on clinical history and physical examination. It is difficult to diagnose in cases of retrocaecal or retro ileal appendix. Appendicectomy is the most commonly performed abdominal surgery. 15-30% of appendicectomy specimen found to be normal. In order to decrease the number of unnecessary appendicectomy, significance of labarotory investigations like White Blood Cells, CReactive Protein, etc have been emphasised. Ultrasonagram abdomen has been widely accepted as the diagnostic tool for appendicitis. Many number of scoring system were developed to arrive the diagnosis. These scoring systems are based on clinical features, laboratory investigations. Some examples are Alvarado, Modified alvarado, Ripasa. Still there is no definitive laboratory marker for acute appendicitis and appendicular perforations. Studies show that serum bilirubin is raised in acute appendicitis and appendicular perforations. But the siginificance of which is not stressed. On bacterial invasion of the appendix, there is transmigration of bacteria and release of proinflammatory cytokines like TNF α,.IL6. The cytokines reach the liver through the superior mesentric vein and may lead to inflammation, abscess and liver dysfunction. OBJECTIVES: The objectives of the study were- 1. To study the relationship between hyperbilirubinemia and acute appendicitis; and to evaluate its credibility as a diagnostic marker for acute appendicitis. 2. To evaluate whether elevated bilirubin levels have a predictive potential for the diagnosis of Appendicular perforation. MATERIALS AND METHODS: The study was conducted in the Department of General Surgery, Govt. Stanley Medical College, Chennai during the period of November 2013 to November 2014. Study design - A prospective non randomised study. Source - The present study was conducted in the Department of Surgery, Govt. Stanley Medical College, Chennai Study period - One year from November 2013 to November 2014. Source of data - Patients admitted with clinical diagnosis of acute appendicitis or appendicular perforation under the Department of Surgery, Govt.stanley medical college,chennai during the study period. Sample size - A total of 100 patients with clinical diagnosis of acute appendicitis or appendicular perforation were studied. Selection criteria: Inclusion criteria - • All patients diagnosed as acute appendicitis clinically on admission. • All patients diagnosed as appendicular perforation clinically on admission. • For both these groups, only patients with histopathological report suggestive of acute appendicitis or appendicular perforation were included. Exclusion criteria - • All patients documented to have a past history ofo Jaundice or Liver disease. o Chronic alcoholism (that is intake of alcohol of > 40 g/day for Men and > 20 g/day in Women for 10 years).71 o Hemolytic disease. o Acquired or congenital biliary disease. • All patients with positive HBsAg. • All patients with cholelithiasis. • All patients with cancer of hepato-biliary system. RESULTS: A total of 100 patients with clinical diagnosis of acute appendicitis or appendicular perforation admitted in the Department of General surgery, Govt.stanley medical college,chennai were studied. As per the study, the age group 11-20years is most commonly affected (44%) followed by age group 21-30 (32%). The youngest patients of this study were of 8 years old while the oldest patient was a 70 year lady. 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 to be a credible aid in diagnosis of acute appendicitis and would be helpful investigation in decision making. Patients with clinical signs and symptoms of appendicitis and with hyperbilirubinemia higher than the normal range 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.