Hyperbilirubinemia as a predictor of gangrenous/perforated appendicitis: a prospective study

BACKGROUND: The aims of the study were: 1) to establish the role of hyperbilirubinemia as a new diagnostic tool to predict gangrenous/perforated appendicitis; and 2) to compare other variables such as age, duration of symptoms, clinical profile, white blood cell count, C-reactive protein and ultrasound in a similar role. METHODS: This is a prospective study conducted on 50 consecutive cases of acute appendicitis admitted to the emergency ward. These were subjected to investigations to support the diagnosis. These cases were also subjected to liver function tests and clinical diagnosis was confirmed perioperatively and post-operatively by histopathological examination. Their clinical and investigative data were compiled and analyzed. Statistical analysis was performed using either chi square test or fisher's exact test. The level of significance was set at P< 0.05. RESULTS: Total serum bilirubin including both direct and indirect was found to be significantly increased in case of acute suppurative appendicitis. Serum bilirubin was much higher (P <0.000) in cases of gangrenous/perforated appendicitis. CONCLUSION: Serum bilirubin is an important adjunct in diagnosing the presence of gangrenous/perforated appendicitis.