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NJBMS - Volume 8, Issue 4, April - June 2018

Pages: 178-183
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Bilirubin - A Predictor Of Appendiceal Perforation

Author: Nandhini. N.E, Ponnudhali. D, Evangeline Jones

Category: Biochemistry

Abstract:

Introduction: Acute appendicitis is the most common abdominal emergency. Any delay in the diagnosis and treatment, could result in life threatening complications like perforated appendicitis. Though non-specific tests like WBC count, C reactive protein are routinely done, they are not of much diagnostic value. Recent studies have shown that increase in pre-operative serum bilirubin levels could predict the occurrence of perforated appendicitis.

Aims and objectives:

1) To assess the serum bilirubin (Total, Direct, Indirect) levels in acute and perforated appendicitis.

2) To look for any associated changes in liver enzymes.

3) To analyze the sensitivity and specificity of serum bilirubin and its utility as a diagnostic/ predictive marker of perforated appendicitis.

Materials and methods: A Retrospective study - Medical records of sixty patients who had underwent open appendicectomy during the last one year were scrutinized and all the relevant information noted . 30 patients who underwent surgery for simple appendicitis formed group 1. 30 patients who underwent surgery for perforated appendicitis formed group 2. Their pre-operative laboratory serum bilirubin values and other liver parameter values were collected and analyzed. All the above parameters were compared between two groups using independent student 't' test and ROC curve obtained for Bilirubin ,with SPSS 23 software.

Results: Total bilirubin levels were significantly increased in patients with perforated appendicitis (p=.000) compared to patients with simple appendicitis. Similar increase in serum direct and indirect bilirubin levels (p=.000) were noticed in perforated appendicitis patients. Total Bilirubin (cut-off: 0.80mg/dl) has sensitivity 80% and specificity 75%.

Conclusion: Assessing serum bilirubin levels pre-operatively could have significant value in predicting appendicular perforation. Serum bilirubin being an inexpensive and routinely done test in all labs, with its high sensitivity and specificity, better qualifies as a diagnostic marker for perforated appendicitis even in a rural care centre.

Keywords: Serum total bilirubin, acute appendicitis, Alvarado's score, perforated appendicitis

DOI: http://dx.doi.org/10.31975/NJBMS.2018.8402

DOI URL: http://dx.doi.org/10.31975/NJBMS.2018.8402