Evaluating serum bilirubin levels in acute appendicitis and appendiceal perforation
DOI:
https://doi.org/10.18203/2320-6012.ijrms20200559Keywords:
Appendicitis, Appendiceal, Hyperbilirubinemia, PerforationAbstract
Background: Acute appendicitis is one of the commonest surgical emergencies. Authors undertook this study to evaluate serum bilirubin levels in acute appendicitis and appendiceal perforation.
Methods: A retrospective study evaluating the serum bilirubin levels in acute appendicitis and appendiceal perforation was carried out for 6 years at three tertiary care hospitals at India from 2014 to 2019. Patients having acute appendicitis and appendiceal perforation, confirmed on histopathology, with no other medical or surgical comorbidity were included in the study.
Results: The total number of our study subjects was 927. 306 patients had appendiceal perforation, amongst these, 226 (74%) had hyperbilirubinemia. Out of the 621 patients having acute appendicitis only 186 (30%) had hyperbilirubinemia. The lowest and the highest serum bilirubin levels of this study group were 0.6 and 3.1 mg/dl, respectively, with an average of 1.6 mg/dl. In patients diagnosed to be having acute appendicitis, the lowest and highest serum bilirubin levels were 0.6 and 2.4 mg/dl, respectively, with an average of 1.3 mg/dl. As for the patients having appendiceal perforation the lowest and highest serum bilirubin levels were 0.8 and 3.1 mg/dl, respectively, with an average of 1.8 mg/dl.
Conclusions: Hyperbilirubinemia is seen in acute appendicitis but predominantly in appendiceal perforation, so serum bilirubin estimation may help us in diagnosing appendiceal perforation pre-operatively if and when used in conjunction with other available diagnostic modalities.
References
Seal A. Appendicitis: a historical review. Canadian journal of surgery. J Canad Chirur. 1981 Jul;24(4):427-33.
Amyand C. VIII. Of an inguinal rupture, with a pin in the appendix coeci, incrusted with stone; and some observations on wounds in the guts. Philosoph Trans Royal Soci London. 1736 Oct;39(443):329-42.
Ramaswami YB, Prakash HS, TC RP, Jabbar FA. Hyperbilirubinemia: a new diagnostic marker for appendicular perforation. Inter Surg J. 2017 Aug 24;4(9):3024-7.
Hong YR, Chung CW, Kim JW, Kwon CI, Ahn DH, Kwon SW, et al. Hyperbilirubinemia is a significant indicator for the severity of acute appendicitis. J Korean Soci Coloproctol. 2012 Oct;28(5):247.
Franke C, Böhner H, Yang Q, Ohmann C, Röher HD. Ultrasonography for diagnosis of acute appendicitis: results of a prospective multicenter trial. World J Surg. 1999 Feb 1;23(2):141.
Cakirer S, Basak M, Colakoglu B, Bankaoglu M. Diagnosis of acute appendicitis with unenhanced helical CT: a study of 130 patients. Emerg Radiol. 2002 Sep 1;9(3):155-61.
Kumar BA, Kalyan KA, Rehman MM. Perforation in acute appendicitis: evaluation of hyperbilirubinemia and elevated C reactive protein as a predictive factor. IAIM. 2017;4(3):18-23.
Panagiotopoulou IG, Parashar D, Lin R, Antonowicz S, Wells AD, Bajwa FM, et al. The diagnostic value of white cell count, C-reactive protein and bilirubin in acute appendicitis and its complications. Annal Royal Coll Surg Eng. 2013 Apr;95(3):215-21.
Ramu TR, Kandhasamy SC, Andappan A. A Prospective Study on the Diagnostic Value of Hyperbilirubinemia as a Predictive Factor for Appendicular Perforation in Acute Appendicitis. Cureus. 2018 Aug;10(8).
Khan S. Evaluation of hyperbilirubinemia in acute inflammation of appendix: a prospective study of 45 cases. Kathmandu Univ Med J. 2006 Jul;4(3):281-9.
Estrada JJ, Petrosyan M, Barnhart J, Tao M, Sohn H, Towfigh S, et al. Hyperbilirubinemia in appendicitis: a new predictor of perforation. J Gastroint Surg. 2007 Jun 1;11(6):714-8.
Chaudhary P, Kumar A, Saxena N, Biswal UC. Hyperbilirubinemia as a predictor of gangrenous/perforated appendicitis: a prospective study. Annal gastroenterol: Quarterly Pub Hellenic Soci Gastroenterol. 2013;26(4):325.
Addiss DG, Shaffer N, Fowler BS, Tauxe RV. The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol. 1990 Nov 1;132(5):910-25.
Sand M, Bechara FG, Holland-Letz T, Sand D, Mehnert G, Mann B. Diagnostic value of hyperbilirubinemia as a predictive factor for appendiceal perforation in acute appendicitis. Am J Surg. 2009 Aug 1;198(2):193-8.
Whiting JF, Green RM, Rosenbluth AB, Gollan JL. Tumor necrosis factor-alpha decreases hepatocyte bile salt uptake and mediates endotoxin‐induced cholestasis. Hepatology. 1995 Oct;22(4):1273-8.
Miller DF, Irvine RW. Jaundice in acute appendicitis. Lancet. 1969 Feb 15;293(7590):321-3.
Atahan K, Üreyen O, Aslan E, Deniz M, Çökmez A, Gür S, et al. Preoperative diagnostic role of hyperbilirubinaemia as a marker of appendix perforation. J Inter Med Res. 2011 Apr;39(2):609-18.
Zimmerman HJ, Fang M, Utili R, Seeff LB, Hoofnagle J. Jaundice due to bacterial infection. Gastroenterology. 1979 Aug 1;77(2):362-74.
Miller DJ, Keeton GR, Webber BL, Saunders SJ. Jaundice in severe bacterial infection. Gastroenterology. 1976 Jul 1;71(1):94-7.
Geier A, Fickert P, Trauner M. Mechanisms of disease: mechanisms and clinical implications of cholestasis in sepsis. Nature Clin Pract Gastroenterol Hepatol. 2006 Oct;3(10):574-85.
Nishida T, Fujita N, Megawa T, Nakahara M, Nakao K. Postoperative hyperbilirubinemia after surgery for gastrointestinal perforation. Surg Today. 2002 Aug 1;32(8):679-84.
Franson TR, Hierholzer Jr WJ, LaBrecque DR. Frequency and characteristics of hyperbilirubinemia associated with bacteremia. Revi Infec Dis. 1985 Jan 1;7(1):1-9.
