Role of Hyperbilirubinemia as a Diagnostic Predictor of Appendicular Perforation

Background and objectives: Acute appendicitis is the most common cause of an 'acute abdomen' in young adults. Diagnosis of appendicitis still remains a dilemma in spite of the advances in various laboratory and radiological investigations. The present study was undertaken to assess relationship between hyperbilirubinemia and acute appendicitis and also, to see whether bilirubin levels have a predictive potential for the diagnosis of appendicular perforation. Methodology This two year cross sectional study was conducted in the department of surgery, MGM Medical College and Hospital, Aurangabad during the period of October 2012 to October 2014. A total of 100 patients with clinical diagnosis of acute appendicitis or appendiceal perforation were studied. The serum bilirubin and liver function tests were carried out in all the patients. Results In this study, Male (72%) outnumbered females (28%) and overall mean age was 30.78 + 16.01 years for the patients of appendicular perforation and 28.38+ 12.32 years. Of the 100 patients, 50% were diagnosed as acute appendicitis while 50% were diagnosed with appendiceal perforatrion. In patients with acute appendicitis, 20% had elevated Bilirubin levels while 80% had normal Bilirubin levels. Among patients with appendiceal perforation, 88% had elevated Bilirubin levels while 12% had normal Bilirubin levels. The sensitivity and specificity of serum Bilirubin as a marker in predicting acute appendicitis and appendiceal perforation was 88% and 80% respectively with positive predictive value and negative predictive value of 81.48% and 86.96% respectively. Conclusion and interpretation Serum Bilirubin levels appears to be a promising new laboratory marker for diagnosing appendicular perforatipon and also promises to have a predictive potential for the diagnosis of appendicular perforation. Clinical signs and symptoms of appendicitis with hyperbilirubinemia is suggestive of higher probability of appendicular perforation.