Prospective Assessment of Elevated Serum Bilirubin Level in Diagnosis of Acute Appendicitis
Advances in Surgical Sciences
Volume 6, Issue 1, June 2018, Pages: 27-30
Received: Apr. 28, 2018;
Accepted: May 22, 2018;
Published: Jun. 12, 2018
Views 927 Downloads 63
Ahmed Abdel-Fattah Elshoura, General Surgery Department, Faculty of Medicine, Tanta University, Tanta, Egypt
Mohamed Hamdy Abo-Ryia, General Surgery Department, Faculty of Medicine, Tanta University, Tanta, Egypt
Ayman Elsadany, General Surgery Department, Faculty of Medicine, Tanta University, Tanta, Egypt
Sherif Abd-Al Fattah Saber, General Surgery Department, Faculty of Medicine, Tanta University, Tanta, Egypt
Gamal Ibrahim Mousa, General Surgery Department, Faculty of Medicine, Tanta University, Tanta, Egypt
Follow on us
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.
Appendicitis, Hyperbilirubinemia, Sensitivity, Specificity
To cite this article
Ahmed Abdel-Fattah Elshoura,
Mohamed Hamdy Abo-Ryia,
Sherif Abd-Al Fattah Saber,
Gamal Ibrahim Mousa,
Prospective Assessment of Elevated Serum Bilirubin Level in Diagnosis of Acute Appendicitis, Advances in Surgical Sciences.
Vol. 6, No. 1,
2018, pp. 27-30.
Copyright © 2018 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/
) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Ditillo MF, James DO, Dziura, et al. (2006) Is it Safe to Delay Appendectomy in Adults with Acute Appendicitia? Ann Surg, 244 (5): 656-660.
Emmanuel A, Murchan P, Wilson I, et al. (2011) The value of hyperbilirubinaemia in the diagnosis of acute appendicitis. Ann R CollSurg Engl, 93 (3): 213-217.
Giordano S, Paakkonen M, Salminen P, et al. (2013). Elevated serum bilirubin in assessing the likelihood of perforation in acute appendicitis: A diagnostic meta-analysis. International Journal of Surgery, 11: 795-800.
Bohgal HK & Sanyal AJ. (2013) The molecular pathogenesis of cholestasis in sepsis. Frontiers in Bioscience, 5 (1): 87-96.
Subramanyam VV, Bangla G and Jyothi C. (2016) Serum bilirubin reliable diagnostic marker in detecting complicated appendicitis. J Evid Based Med Healthc, 3 (2): 66-71.
Kanumba ES, Mabula JB, Rambau P, et al. (2011) Modified Alvarado scoring system as a diagnostic tool for acute appendicitis at Bugando Medical Centre, Mwanza, Tanzania. BMC Surg, 11 (4): 1-5.
McGowan DR, Sims HM, Zia K, et al. (2013) The value of biochemical markers in predicting a perforation in acute appendicitis. ANZ J Surg, 83: 79-83.
D’Souza N, Karim D, Sunthareswaran R, et al. (2013) Bilirubin: a diagnostic marker for appendicitis. International Journal of Surgery, 11: 1114-1117.
Sand M, Bechara FG, Holland-Letz T, et al. (2009) Diagnostic value of hyperbilirubinemia as a predictive factor for appendiceal perforation in acute appendicitis. Am. J. Surg, 198: 193–198.
Burcharth J, Pommergaard HC, Rosenberg J, et al. (2013) Hyperbilirubinemia as a predictor for appendiceal perforation: a systematic review. Scand. J. Surg, 102: 55–60.