Evaluation of hyperbilirubinaemia as a new diagnostic marker for acute appendicitis & its role in prediction of appendicular perforation
Keywords:
Acute appendicitis, Appendiceal perforation, Hyperbilirubinemia
Abstract
Introduction: Acute appendicitis is the most common general surgical emergency and early surgical intervention improves outcomes. The diagnosis of appendicitis can be elusive, and a high index of suspicion is important in preventing serious complications from this disease. The present study was undertaken to assess relationship between hyperbilirubinemia and acute appendicitis to evaluate its credibility as a diagnostic marker for acute appendicitis.
Material & methods: The case control study was carried out on 60 patients who were clinically diagnosed as having acute/perforated appendicitis and on 60 healthy volunteers from the community having no signs and symptoms of acute appendicitis. The evaluation of acute appendicitis was done by history taking ,clinical examination and investigations including CBC, Ultrasonography and confirmed by histopathological examination of appendicectomy specimen. For the final analysis various statistical methods like descriptive, crosstabs, chi-square test were applied using the SPSS (version 20.0).
Results: Total serum bilirubin level was raised in 43 patients (71.7%) out of the total sample of 60 cases. Of these, 42(70%) cases were positive for appendicitis on HPE (True Positive), and 1(1.7%) was negative on HPE (false positive). Among the 17(28.3%) cases in whom serum bilirubin was not raised, in 3(5%) cases HPE was negative (True Negative), and in 14 (23.3%) cases HPE was positive (False Negative). In 60 healthy individuals mean serum bilirubin was 0.7±0.3 mg%. In 46 cases of histopathologically proved acute appendicitis (non-perforated) the mean serum bilirubin was 1.3±7mg% while in perforated group it was 2.5±1.1mg% (P value was significant i.e. <0.001).
Conclusion: Serum bilirubin is an important adjunct in diagnosing the presence of gangrenous/perforated appendicitis. Our findings confirm that hyperbilirubinaemia has a high specificity for distinguishing acute appendicitis.
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References
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26. Bruwer F, Coetzer M, Warren BL. Laparoscopic versus open surgical exploration in premenopausal women with suspected acute appendicitis. S Afr J Surg. 2003 Nov;41(4):82-5.
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28. Estrada JJ, Petrosyan M, et al. Hyperbilirubinemia in appendicitis: a new predictor of perforation. J Gastrointest Surg. 2007 Jun;11(6):714-8. [PubMed]
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30. Lee JH, Park YS, Choi JS. The epidemiology of appendicitis and appendectomy in South Korea: national registry data. J Epidemiol. 2010;20(2):97-105. Epub 2009 Dec 19. [PubMed]
31. Buckius MT, McGrath B, Monk J, Grim R, Bell T, Ahuja V. Chang¬ing epidemiology of acute appendicitis in the United States: study period 1993-2008. J Surg Res. 2012 Jun 15;175(2):185-90. doi: 10.1016/j.jss.2011.07.017. Epub 2011 Aug 9.
32. Fike FB, Mortellaro VE, Juang D, Sharp SW, Ostlie DJ, St Peter SD. The impact of postoperative abscess formation in perforated appendicitis. J Surg Res. 2011 Sep;170(1):24-6. doi: 10.1016/j.jss.2011.03.038. Epub 2011 Apr 13. [PubMed]
33. Cardall T, Glasser J, Guss DA. Clinical value of the total white blood cell count and temperature in the evaluation of patients with suspected appendicitis. Acad Emerg Med. 2004 Oct;11(10):1021-7.
34. West WM, Brady-West DC, McDonald AH, Hanchard B, Fearon-Boothe D. Ultrasound and white blood cell counts in suspected acute appendicitis. West Indian Med J. 2006 Mar;55(2):100-2.
35. Guraya YS, Al-Tuwaijri TA, Khairy GA, Murshid KR. Validity of leukocyte count to predict the severity of acute appendicitis. Saudi Med J. 2005 Dec;26(12):1945-7. [PubMed]
36. SALMAN KHAN. The diagnostic value of hyperbilirubinemia and total leucocyte count in the evaluation of acute appendicitis .Journal of Clinical and diagnostic Research 2009 August [cited: 2009 August 3:1647-1652.
37. Khan S. Elevated serum bilirubin in acute appendicitis: a new diagnostic tool. Kathmandu university medical journal 2008; 6 (2): 161-165.
38. Atahan K, Üreyen O, Aslan E, Deniz M, Çökmez A, Gür S, Avci A, Tarcan E. Preoperative diagnostic role of hyperbilirubinaemia as a marker of appendix perforation. J Int Med Res. 2011;39(2):609-18. [PubMed]
39. Sand M, Bechara FG, Holland-Letz T, Sand D, Mehnert G, Mann B. Diagnostic value of hyperbilirubinemia as a predictive factor for appendiceal perforation in acute appendicitis. Am J Surg. 2009 Aug;198(2):193-8. doi: 10.1016/j.amjsurg.2008.08.026. Epub 2009 Mar 23.
40. Poras Chaudhary, Ajay Kumar, Neeraj Saxena, and Upendra C. Biswal et al: Hyperbilirubinemia as a predictor of gangrenous/perforated appendicitis: a prospective study Ann. Gastroenterology. 2013; 26(4): 325–331.
41. Young Ran Hong, Chul-Woon Chung, Jong Woo Kim, Chang Il Kwon, Dae Ho Ahn, Sung Won Kwon, Seong Ki Kim et al: Hyperbilirubinemia Is a Significant Indicator for the Severity of acute appendicitis. J Korean Soc Coloproctol 2012; 28(5):247-252.
42. Emmanuel A, Murchan P, Wilson I, Balfe P. The value of hyperbilirubinaemia in the diagnosis of acute appendicitis. The value of hyperbilirubinaemia in the diagnosis of acute appendicitis. [PubMed]
43. Käser SA, Fankhauser G, Willi N et al: C-reactive protein is superior to bilirubin for anticipation of perforation in acute appendicitis. Scand J Gastroenterol 2010;45:885–892.
44. Scholz P, Lenoir U, Borbély Y. Letter to the Editor regarding Adams HL, Jaunoo SS. Hyperbilirubinaemia in appendicitis: the diagnostic value for prediction of appendicitis and appendiceal perforation. Eur J Trauma Emerg Surg. 2016; 42:249-52. Eur J Trauma Emerg Surg. 2016 Aug;42(4):529. doi: 10.1007/s00068-016-0699-9. Epub 2016 Jun 22.
2. Körner H, Söreide JA, Pedersen EJ, Bru T, Söndenaa K, Vatten L. Stability in incidence of acute appendicitis. A population-based longitudinal study. Dig Surg. 2001;18(1):61-6.
3. Harrison MW, Lindner DJ, Campbell JR, Campbell TJ. Acute Appendicitis in children: factors affecting morbidity. Am J Surg. 1984 May;147(5):605-10. [PubMed]
4. Savrin RA, Clatworthy HW., Jr Appendiceal rupture: a continuing diagnostic problem. Pediatrics. 1979 Jan;63(1):36-43. [PubMed]
5. Scher KS, Coil JA. The continuing challenge of perforating appendicitis. Surg Gynecol Obstet. 1980 Apr;150(4):535-8. [PubMed]
6. Karakas SP, Guelfguat M, Leonidas JC, Springer S, Singh SP. Acute appendicitis in children: comparison of clinical diagnosis with ultrasound and CT imaging. Pediatr Radiol. 2000 Feb;30(2):94-8.
7. Hoffmann J, Rasmussen OO. Aids in the diagnosis of acute appendicitis. Br J Surg. 1989 Aug;76(8):774-9. [PubMed]
8. Oruc MT, Kulah B, Ozozan O, et al. The value of 5-hydroxyl indole acetic acid measurement in spot urine in diagnosis of acute appendicitis. East Afr Med J. 2004 Jan;81(1):40-1.
9. Taha AS, Grant V, Kelly RW. Urine analysis for interleukin-8 in the non-invasive diagnosis of acute and chronic inflammatory diseases. Postgrad Med J. 2003;79:159–163. [PubMed]
10. Hallan S, Asberg A. The accuracy of C-reactive protein in diagnosing acute appendicitis – a meta analysis. Scand J Clin Lab Invest. 1997 Aug;57(5):373-80.
11. Goodwin AT, Swift RI, Bartlett MJ, Fernando BS, Chadwick SJ. Can serum interleukin-6 levels predict the outcome of patients with right iliac fossa pain? Ann R Coll Surg Engl. 1997;79:130–133. [PubMed]
12. Vermeulen B, Morabia A, Unger PF. Influence of white cell count on surgical decision making in patients with abdominal pain in the right lower quadrant. Eur J Surg. 1995;161:483–486.
13. Albu E, Miller BM, Choi Y, Lakhanpal S, Murthy RN, Gerst PH. Diagnostic value of C-reactive protein in acute appendicitis. Dis Colon Rectum. 1994 Jan;37(1):49-51. [PubMed]
14. Christian F, Christian GP. A simple scoring system to reduce the negative appendicectomy rate. Ann R Coll Surg Engl. 1992 Jul;74(4):281-5. [PubMed]
15. Alvarado A. A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med. 1986 May;15(5):557-64. [PubMed]
16. Ohmann C, Franke C, Yang Q. Clinical benefit of a diagnostic score for appendicitis: results of a prospective interventional study. German Study Group of Acute Abdominal Pain. Arch Surg. 1999;134:993–996.
17. Zielke A, Sitter H, Rampp T, et al. Can diagnostic scoring systems help decision making in primary care of patients with suspected acute appendicitis? Zielke Dtsch Med Wochenschr. 1999;124:545–550.
18. Douglas CD, Macpherson NE, Davidson PM, Gani JS. Randomised controlled trial of ultrasonography in diagnosis of acute appendicitis, incorporating the Alvarado score. BMJ. 2000;321:919–922.
19. Rettenbacher T, Hollerweger A, Gritzmann N, et al. Appendicitis: should diagnostic imaging be performed if the clinical presentation is highly suggestive of the disease? Gastroenterology. 2002;123:992–998.
20. Walker S, Haun W, Clark J, McMillin K, Zeren F, Gilliland T. The value of limited computed tomography with rectal contrast in the diagnosis of acute appendicitis. Am J Surg. 2000 Dec;180(6):450-4; discussion 454-5.
21. Hong JJ, Cohn SM, Ekeh AP, Newman M, Salama M, Leblang SD. A prospective randomized study of clinical assessment versus computed tomography for the diagnosis of acute appendicitis. Surg Infect (Larchmt). 2003 Fall;4(3):231-9.
22. Colak T, Gungor F, Ozugur S, et al. The value of 99mTc-HMPAO labelled white blood cell scintigraphy in acute appendicitis patients with an equivocal clinical presentation. Eur J Nucl Med. 2001;28:575–580.
23. Incesu L, Coskun A, Selcuk MB, Akan H, Sozubir S, Bernay F. Acute appendicitis: MR imaging and sonographic correlation. AJR Am J Roentgenol. 1997 Mar;168(3):669-74. [PubMed]
24. Larsson PG, Henriksson G, Olsson M, et al. Laparoscopy reduces unnecessary appendicectomies and improves diagnosis in fertile women. A randomized study. Surg Endosc. 2001;15:200–202.
25. Lamparelli MJ, Hoque HM, Pogson CJ, Ball AB. A prospective evaluation of the combined use of the modified Alvarado score with selective laparoscopy in adult females in the management of suspected appendicitis. Ann R Coll Surg Engl. 2000;82:192–195.
26. Bruwer F, Coetzer M, Warren BL. Laparoscopic versus open surgical exploration in premenopausal women with suspected acute appendicitis. S Afr J Surg. 2003 Nov;41(4):82-5.
27. Sand M, Bechara FG, Holland-Letz T, Sand D, Mehnert G, Mann B. Diagnostic value of hyperbilirubinemia as a predictive factor for appendiceal perforation in acute appendicitis. Am J Surg. 2009 Aug;198(2):193-8. doi: 10.1016/j.amjsurg.2008.08.026. Epub 2009 Mar 23. [PubMed]
28. Estrada JJ, Petrosyan M, et al. Hyperbilirubinemia in appendicitis: a new predictor of perforation. J Gastrointest Surg. 2007 Jun;11(6):714-8. [PubMed]
29. Sand M, Bechara FG, et al. Diagnostic value of hyperbilirubinemia as a predictive factor for appendiceal perforation in acute appendicitis. Am J Surg. 2009 Aug;198(2):193-8. doi: 10.1016/j.amjsurg.2008.08.026. Epub 2009 Mar 23. [PubMed]
30. Lee JH, Park YS, Choi JS. The epidemiology of appendicitis and appendectomy in South Korea: national registry data. J Epidemiol. 2010;20(2):97-105. Epub 2009 Dec 19. [PubMed]
31. Buckius MT, McGrath B, Monk J, Grim R, Bell T, Ahuja V. Chang¬ing epidemiology of acute appendicitis in the United States: study period 1993-2008. J Surg Res. 2012 Jun 15;175(2):185-90. doi: 10.1016/j.jss.2011.07.017. Epub 2011 Aug 9.
32. Fike FB, Mortellaro VE, Juang D, Sharp SW, Ostlie DJ, St Peter SD. The impact of postoperative abscess formation in perforated appendicitis. J Surg Res. 2011 Sep;170(1):24-6. doi: 10.1016/j.jss.2011.03.038. Epub 2011 Apr 13. [PubMed]
33. Cardall T, Glasser J, Guss DA. Clinical value of the total white blood cell count and temperature in the evaluation of patients with suspected appendicitis. Acad Emerg Med. 2004 Oct;11(10):1021-7.
34. West WM, Brady-West DC, McDonald AH, Hanchard B, Fearon-Boothe D. Ultrasound and white blood cell counts in suspected acute appendicitis. West Indian Med J. 2006 Mar;55(2):100-2.
35. Guraya YS, Al-Tuwaijri TA, Khairy GA, Murshid KR. Validity of leukocyte count to predict the severity of acute appendicitis. Saudi Med J. 2005 Dec;26(12):1945-7. [PubMed]
36. SALMAN KHAN. The diagnostic value of hyperbilirubinemia and total leucocyte count in the evaluation of acute appendicitis .Journal of Clinical and diagnostic Research 2009 August [cited: 2009 August 3:1647-1652.
37. Khan S. Elevated serum bilirubin in acute appendicitis: a new diagnostic tool. Kathmandu university medical journal 2008; 6 (2): 161-165.
38. Atahan K, Üreyen O, Aslan E, Deniz M, Çökmez A, Gür S, Avci A, Tarcan E. Preoperative diagnostic role of hyperbilirubinaemia as a marker of appendix perforation. J Int Med Res. 2011;39(2):609-18. [PubMed]
39. Sand M, Bechara FG, Holland-Letz T, Sand D, Mehnert G, Mann B. Diagnostic value of hyperbilirubinemia as a predictive factor for appendiceal perforation in acute appendicitis. Am J Surg. 2009 Aug;198(2):193-8. doi: 10.1016/j.amjsurg.2008.08.026. Epub 2009 Mar 23.
40. Poras Chaudhary, Ajay Kumar, Neeraj Saxena, and Upendra C. Biswal et al: Hyperbilirubinemia as a predictor of gangrenous/perforated appendicitis: a prospective study Ann. Gastroenterology. 2013; 26(4): 325–331.
41. Young Ran Hong, Chul-Woon Chung, Jong Woo Kim, Chang Il Kwon, Dae Ho Ahn, Sung Won Kwon, Seong Ki Kim et al: Hyperbilirubinemia Is a Significant Indicator for the Severity of acute appendicitis. J Korean Soc Coloproctol 2012; 28(5):247-252.
42. Emmanuel A, Murchan P, Wilson I, Balfe P. The value of hyperbilirubinaemia in the diagnosis of acute appendicitis. The value of hyperbilirubinaemia in the diagnosis of acute appendicitis. [PubMed]
43. Käser SA, Fankhauser G, Willi N et al: C-reactive protein is superior to bilirubin for anticipation of perforation in acute appendicitis. Scand J Gastroenterol 2010;45:885–892.
44. Scholz P, Lenoir U, Borbély Y. Letter to the Editor regarding Adams HL, Jaunoo SS. Hyperbilirubinaemia in appendicitis: the diagnostic value for prediction of appendicitis and appendiceal perforation. Eur J Trauma Emerg Surg. 2016; 42:249-52. Eur J Trauma Emerg Surg. 2016 Aug;42(4):529. doi: 10.1007/s00068-016-0699-9. Epub 2016 Jun 22.
CITATION
DOI: 10.17511/ijoso.2016.i04.04
Published: 2016-12-31
How to Cite
Chandel, U. K., Sharma, D., Surinder, S., & Malhotra, P. (2016). Evaluation of hyperbilirubinaemia as a new diagnostic marker for acute appendicitis & its role in prediction of appendicular perforation. Surgical Review: International Journal of Surgery, Trauma and Orthopedics, 2(4), 71-78. https://doi.org/10.17511/ijoso.2016.i04.04
Section
Original Article
OAI - Open Archives Initiative
Therapoid
