scholarly journals Study of serum bilirubin as a diagnostic method to predict acute perforated appendicitis

2021 ◽  
Author(s):  
Valarmathi Marimuthu ◽  
Chiddharth Venkateshan Ilamparuthi
Keyword(s):  
Acute Appendicitis ◽  
Bilirubin Level ◽  
Open Appendectomy ◽  
Perforated Appendicitis ◽  
Liver Function Tests ◽  
Duration Of Symptoms ◽  
Cell Counts ◽  
Major Procedure ◽  
White Blood Cell Counts ◽  
Appendiceal Perforation

Background: Acute appendicitis is the commonest cause of ‘acute surgical abdomen’. Appendicectomy is the most frequently performed urgent abdominal operation and is often the first major procedure performed by a surgeon in training. The aim of the study was to whether hyperbilirubinemia might be used as a diagnostic tool to predict perforated appendicitis.Methods: This study comprised patients who presented with the condition of appendicitis and abnormal liver function tests on admission and had a laparoscopic or open appendectomy. The age information, duration of symptoms, temperature, white blood cell counts, bilirubin levels, and histology data were gathered. Peritoneal fluid was cultured and examined for sensitivity.Results: The average bilirubin level of all participating patients was 0.92 mg/dl (range, 0.1-4.3 mg/dl). The mean bilirubin levels were higher for patients with simple appendicitis compared to those with a non-inflamed appendix (0.7 mg/dl and 0.4 mg/dl, p<0.001). Hyperbilirubinaemia was reported to have a specificity of 89% and a positive predictive value of 90.02% for acute appendicitis. Patients with appendiceal perforation, however, had a mean bilirubin level of 1.7 mg/dl and were more likely to have hyperbilirubinaemia (p<0.001). The specificity of hyperbilirubinaemia for perforation or gangrene was 73%.Conclusions: Patients with hyperbilirubinemia with appendicitis condition should be screened for a greater risk of appendiceal perforation than those with normal bilirubin levels.  

scholarly journals Hyperbilirubinemia as a diagnostic tool in patients with perforated appendicitis: a prospective study

2020 ◽  
Vol 7 (6) ◽  
pp. 1728
Author(s):  
Deepak Gopalreddy ◽  
Dinesh L. Jadhav ◽  
Sagar Kannavar
Keyword(s):  
Bilirubin Level ◽  
Diagnostic Tool ◽  
Clinical Symptoms ◽  
Open Appendectomy ◽  
Perforated Appendicitis ◽  
Liver Function Tests ◽  
Duration Of Symptoms ◽  
Cell Counts ◽  
The Mean ◽  
Appendiceal Perforation

Background: This study was conducted to determine the effectiveness of hyperbililrubinemia as diagnostic tool to predict perforated appendicitis.Methods: Patients presenting to department of general surgery of SS Medical College and Hospital during the period from June 2017 to June 2019 with features of appendicitis and liver function tests on admission undergoing laparoscopic or open appendectomy were included in this study. Age, duration of symptoms, temperature, white blood cell counts, bilirubin levels and histological data were collected. Culture and sensitivity of peritoneal fluid was done. Patients were grouped according to histological examination of appendectomy specimens and comparison was made between the groups.Results: The mean bilirubin level of all patients was 0.95 mg/dl (range, 0.1-4.3 mg/dl). The mean bilirubin levels were higher for patients with simple appendicitis compared to those with a non-inflamed appendix (0.8 mg/dl and o.5 mg/dl, p<0.001). Hyperbilirubinaemia had a specificity of 88% and a positive predictive value of 88.89% for acute appendicitis. Patients with appendiceal perforation, however, had a mean bilirubin level of 1.5 mg/dl and were more likely to have hyperbilirubinaemia (p<0.001). The specificity of hyperbilirubinaemia for perforation or gangrene was 70%.Conclusions: patients with hyperbilirubinemia and clinical symptoms of appendicitis should be identified as having a higher probability of appendiceal perforation than those with normal bilirubin levels. Hyperbilirubinemia alone is not a strong enough predictor, but might be more useful when integrated into a scoring system.

scholarly journals Diagnostic value of serum hyperbilirubinemia in acute appendicitis and its complications

2017 ◽  
Vol 4 (5) ◽  
pp. 1710
Author(s):  
Farooq A. Mir ◽  
Shaugfta Aara ◽  
Masrat Jan ◽  
Nisar A. Wani
Keyword(s):  
Acute Appendicitis ◽  
Bilirubin Level ◽  
Predictive Factor ◽  
Serum Bilirubin ◽  
Perforated Appendicitis ◽  
Diagnostic Value ◽  
Significant Difference ◽  
Perforated Appendix ◽  
The Mean ◽  
Appendiceal Perforation

Background: To increase diagnostic accuracy and to decrease complication rates secondary to acute appendicitis, a variety of different approaches have been described, including predictive scoring systems. To prevent the catastrophic effects of perforated appendix, a surgeon needs diagnostic tools which may signal perforation of appendix at earliest, as a result of which the delay in the management of perforated appendix will not be witnessed. Keeping in view the above facts, the diagnostic value of serum bilirubin in acute appendicitis and its complications has been evaluated.Methods: This prospective study was conducted on 100 patients who presented with clinical diagnosis of Acute Appendicitis. Role of serum bilirubin as a diagnostic tool in acute appendicitis and diagnostic value of hyperbilirubinemia as a predictive factor for appendiceal perforation was evaluated. . Estimation of serum bilirubin was done by Jendrassik and Gorf method using Hitachi – 912 automatic biochemistry analyzer. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of the investigations in the diagnosis of the acute appendicitis were calculated.Results: Serum bilirubin levels had a sensitivity of 84.1% and specificity of 83.3% in the diagnosis of acute appendicitis. The mean bilirubin level of patients with gangrenous appendicitis (2.1±1.2mg/dl) was significantly higher than the mean bilirubin level of patients with simple acute appendicitis (1.5 ±0.6)   (p1=0.030 sig). A statistically significant difference was also observed in the mean bilirubin level of patients with perforated appendicitis (mean=2.9±1.6mg/dl) and mean bilirubin level of patients with simple acute appendicitis (p2=<0.0001 sig). However statistically non-significant difference was observed between the mean bilirubin level of patients with gangrenous and perforated appendicitis (p3=0.056 non- sig).Conclusions:Pre-operative assessment of serum bilirubin not only helps in acute appendicitis but also serves as a predictive factor for appendiceal perforation. 

scholarly journals Role of C-Reactive Protein, White Blood Cell Counts, Bilirubin Levels, and Imaging in the Diagnosis of Acute Appendicitis as a Cause of Right Iliac Fossa Pain

Cureus ◽  
2018 ◽  
Author(s):  
Shetty Sushruth ◽  
Chellappa Vijayakumar ◽  
Krishnamachari Srinivasan ◽  
Nagarajan Raj Kumar ◽  
Gopal Balasubramaniyan ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Blood Cell ◽  
Iliac Fossa ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Cell Counts ◽  
Blood Cell Counts ◽  
Right Iliac Fossa Pain ◽  
White Blood Cell Counts

scholarly journals Laparoscopic Appendectomy Trends and Outcomes in the United States: Data from the Nationwide Inpatient Sample (NIS), 2004–2011

2014 ◽  
Vol 80 (10) ◽  
pp. 1074-1077 ◽  
Author(s):  
Hossein Masoomi ◽  
Ninh T. Nguyen ◽  
Matthew O. Dolich ◽  
Steven Mills ◽  
Joseph C. Carmichael ◽  
...  
Keyword(s):  
United States ◽  
Acute Appendicitis ◽  
Laparoscopic Appendectomy ◽  
Conversion Rate ◽  
Nationwide Inpatient Sample ◽  
Open Appendectomy ◽  
Perforated Appendicitis ◽  
The United States ◽  
Hospital Charges ◽  
Nationwide Inpatient Sample Database

Laparoscopic appendectomy (LA) is becoming the standard procedure of choice for appendicitis. We aimed to evaluate the frequency and trends of LA for acute appendicitis in the United States and to compare outcomes of LA with open appendectomy (OA). Using the Nationwide Inpatient Sample database, we examined patients who underwent appendectomy for acute appendicitis from 2004 to 2011. A total of 2,593,786 patients underwent appendectomy during this period. Overall, the rate of LA was 60.5 per cent (children: 58.1%; adults: 63%; elderly: 48.7%). LA rate significantly increased from 43.3 per cent in 2004 to 75 per cent in 2011. LA use increased 66 per cent in nonperforated appendicitis versus 100 per cent increase in LA use for perforated appendicitis. The LA rate increased in all age groups. The increased LA use was more significant in male patients (84%) compared with female patients (62%). The overall conversion rate of LA to OA was 6.3 per cent. Compared with OA, LA had a significantly lower complication rate, a lower mortality rate, a shorter mean hospital stay, and lower mean total hospital charges in both nonperforated and perforated appendices. LA has become an established procedure for appendectomy in nonperforated and perforated appendicitis in all rates exceeding OA. Conversion rate is relatively low (6.3%).

scholarly journals Acute Appendicitis in Pregnancy and the Developing World

2017 ◽  
Vol 2017 ◽  
pp. 1-5 ◽  
Author(s):  
Tika Ram Bhandari ◽  
Sudha Shahi ◽  
Sarita Acharya
Keyword(s):  
Acute Appendicitis ◽  
Open Appendectomy ◽  
Treatment Protocol ◽  
Fetal Loss ◽  
Perforated Appendicitis ◽  
Length Of Hospital Stay ◽  
Reproductive Age ◽  
Perioperative Outcomes ◽  
Resource Poor Setting ◽  
Negative Appendectomy

Background. Acute appendicitis is the commonest nonobstetric surgical emergency during pregnancy. The aim of the study was to compare perioperative outcomes of acute appendicitis in pregnant and nonpregnant patients. Methods. A retrospective review of medical records of 56 pregnant patients between 2011 and 2016 who were compared with 164 nonpregnant women of reproductive age who underwent open appendectomy between 2014 and 2016 for acute appendicitis. The patient’s demographics and perioperative data were analyzed. Results. The median age of pregnant and nonpregnant patients observed was 26 years (range 19–37) and 26 years (range 18–43). There were no significant differences between the groups in negative appendectomy (21.4 and 21.3%, P=0.52), perforated appendicitis (25 and 23.8%, P=0.85), postoperative complications (28.6 and 26.8%, P=0.80), and median length of hospital stay (5 and 4.5 days, P=0.36). There were 3.6% preterm labour, no maternal mortality, and no fetal loss. In multivariate analysis, WBC >18000/mm3 and long patient time to surgery were independent risk factors for appendicular perforation and postoperative complication (P<0.05). Conclusion. Our results of appendectomy in pregnant patients are comparable with nonpregnant patients. Hence the same perioperative treatment protocol can be followed in pregnant and nonpregnant patients even in resource-poor setting.

scholarly journals Elevated serum bilirubin in acute appendicular perforation as a newer serum marker: a diagnostic validation test

2020 ◽  
Vol 7 (2) ◽  
pp. 414
Author(s):  
Bhimanagouda V. Goudar ◽  
Varsha R. Kanchan
Keyword(s):  
Acute Appendicitis ◽  
Serum Bilirubin ◽  
Elevated Serum ◽  
Liver Function Tests ◽  
Serum Marker ◽  
Serum Total Bilirubin ◽  
Histopathological Diagnosis ◽  
Delay In Diagnosis ◽  
Major Procedure ◽  
A Prospective Study

Background: Acute appendicitis is the commonest cause of acute surgical abdomen. Appendicectomy is the most frequently performed urgent abdominal operation and is often the first major procedure performed by a surgeon in training. Delay in diagnosis and treatment results in increased rate of perforation, morbidity, mortality and hospital stay.Methods: A prospective study where a total of 100 patients with clinical, radiological and histopathological diagnosis of acute appendicitis or appendicular perforation were studied. The liver function tests were carried out in all the patients.Results: In a study group of 100 patients (74 males and 26 females); 59 cases were acute appendicitis and 41 cases were appendiceal perforation proven histopathological. Out of which 48 cases had elevated serum bilirubin levels i.e., 17 in acute appendicitis group and 31 in appendicular perforation group. The mean serum total bilirubin is 1±0.4 in acute appendicitis cases and 1.9±1.13 in the appendicular perforation cases. Similarly, the sensitivity and specificity of elevated serum bilirubin as a diagnostic marker in appendicular perforation was found to be 75.6% and 71.2% respectively.Conclusions: Elevated serum bilirubin levels appears to be a promising new supplemental diagnostic serum marker in Appendicular Perforation and perhaps be a decision-making investigation. 

scholarly journals ROLE OF HYPERBILIRUBINEMIA IN PREDICTON OF GANGRENOUS/PERFORATED APPENDICITIS

2021 ◽  
Vol 5 (7) ◽  
Author(s):  
Irfan Hussain Khan ◽  
Arun Bhargava
Keyword(s):  
Acute Appendicitis ◽  
Prospective Study ◽  
Bilirubin Level ◽  
Diagnostic Tool ◽  
Liver Enzymes ◽  
Serum Bilirubin ◽  
Perforated Appendicitis ◽  
Total Serum Bilirubin ◽  
Total Serum

Introduction: The aim of this study was to determine the role of hyperbilirubinemia as a new diagnostic tool for predictor of gangrenous / perforated appendicitis. Methods: Hospital based prospective study was conducted on 100 patients with perforated/gangrenous appendix Results: In acute appendicitis case out of 84 cases 26 cases bilirubin level was more than 1mg/dl, in gangrenous appendicitis out of 3 cases all cases bilirubin level was more than 1mg/dl and in perforated appendicitis out of 13 cases 12 cases bilirubin level was more than 1mg/dl Conclusion: It is concluded from present study that elevated total serum bilirubin without elevation of liver enzymes is a good indicator of appendicular perforation. Keywords: Perforation, Appendicitis, Bilirubin

scholarly journals Evaluation of role of hyperbilirubinemia as a new diagnostic marker of complicated appendicitis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sabyasachi Bakshi ◽  
Nilay Mandal
Keyword(s):  
Acute Appendicitis ◽  
Likelihood Ratio ◽  
Bilirubin Level ◽  
Predictive Value ◽  
Total Bilirubin ◽  
Serum Bilirubin ◽  
Perforated Appendicitis ◽  
Total Bilirubin Level ◽  
Complicated Appendicitis

Abstract Background In appendicitis, elevated intra-luminal pressure and ischemic necrosis of mucosa causes tissue gangrene or perforation. This leads to cytotoxin facilitated progressive bacterial invasion or translocation into the hepatic parenchyma through portal system. This phenomenon interferes with the bilirubin excretion into the bile canaliculi. In the present study, establishment of a possible role of hyperbilirubinemia as a marker of gangrenous/perforated appendicitis has been studied. Methods After matching the inclusion and exclusion criteria, all cases of clinically diagnosed acute appendicitis were taken for this prospective, single center, observational study. Per-operative diagnosis was confirmed by histopathological examination. Results Out of 110 subjects of acute appendicitis 41 subjects (37.27%) had hyperbilirubinemia. Out of 35 subjects diagnosed as complicated appendicitis 32 subjects (91.42%) had raised total bilirubin levels, while the remaining 03 (8.58%) had normal levels. Among 75 subjects diagnosed as acute simple appendicitis 09 subjects (12%) had raised total bilirubin level, while the remaining 66 subjects (88%) had normal levels. It was Mixed Type of Hyperbilirubinemia in gangrenous/perforated appendicitis. The sensitivity of Total serum bilirubin in predicting complicated appendicitis was found 91.43% (76.942% to 98.196%), where as the specificity of this test was 88.00% (78.439% to 94.363%). positive predictive value and negative predictive value were 78.03% and 95.65% respectively. Positive likelihood ratio and negative likelihood ratio were found to be 7.619 and 0.097 respectively taking prevalence of complicated appendicitis be 31.80%. Receiver Operating Characteristic curve was obtained which shows optimal criterion at Total Bilirubin Level 1.06 mg/dl where sensitivity was 91.43% and specificity was 97.33% at 95% confidence interval with 31.8% disease prevalence. Conclusions This is to conclude that Serum bilirubin level estimation, which is a simple, cheap and easily available laboratory test, can be added to the routine investigations in clinically suspected cases of acute appendicitis for early diagnosis of complications. Trial registration Registered with Clinical Trials Registry-India (ICMR-NIMS) with Registration number CTRI/2019/05/018879 Dated 01/05/2019. This was a prospective trial. Trial URL: http://ctri.nic.in/Clinicaltrials/pdf_generate.php?trialid=33113&EncHid=99780.32960&modid=1&compid=19%27,%2733113det%27.

Sign in / Sign up

Export Citation Format

Share Document