Evaluation of Hyperbilirubinemia as a New Diagnostic Marker for Acute Appendicitis and it's Role in the Prediction of Appendicular Perforation

Dr. Ratla N. Bharat Singh Naik, Dr. Nagasunitha Kumbha, Dr. Adicherla Naveen Kumar, Dr. Vishnu Sree

Abstract: Background: Hyperbilirubinemiain acute approach, serological markers for appendicitis and it?s perforation, additives and strengthening the existing scoring systems, decrease rate of negative appendicectomy, early & non invasive diagnosis of appendicular perforation. Materials and methods: A prospective non - randomized study conducted in Department of General Surgery, Government Siddhartha Medical College, Vijayawada during the period of October 2021 to November 2022. Results: Of the the fifty patients studied 42 were diagnosed to have acute appendicitis and 8 were diagnosed to have appendicular perforation.36 patients (85.7%) of the total patients diagnosed with Acute appendicitis (n=42) were found to have elevated bilirubin levels (> 1.0 mg/dL) while 6 patients (14.2%) had normal bilirubin levels (? 1.0 mg/dL). Similarly, 7 patients (87.5%) of the total patients diagnosed with Appendicular perforation (n=8) were found to have elevated bilirubin levels (> 1.0 mg/dL) while 1 patient (12.5%) had normal bilirubin levels (? 1.0 mg/dL). The mean bilirubin levels in patients diagnosed with Acute appendicitis was 1.45 ?0.65 mg/dL (range, 0.75 ? 2.05 mg/dL) while in patients diagnosed with Appendicular perforation was 1.92?1.16 mg/dL (range, 0.74 ? 3.06 mg/dL). The Sensitivity and Specificity of serum bilirubin as a marker in predicting acute appendicitis and Appendicular perforation was 83.7% and 12.5% respectively. Similarly the Positive predicative value and Negative predicative value for the same is 78.7% and 14.2% respectively. The Odds ratio was calculated to be 0.85. Conclusion: The present study suggests - Serum bilirubin levels appears to be a promising new laboratory marker for diagnosing acute appendicitis, however diagnosis of appendicitis remains essentially still - clinical. Patients with clinical signs and symptoms of appendicitis and with hyper bilirubinemia higherthe normal range should be identified as having a higher probability of Appendicular perforation suggesting, serum bilirubin levels have an adequate predictivepotential for the diagnosis of Appendicular perforation.

Keywords: Hyperbilirubinemia, acute appendicitis, appendicular perforation