Introduction: Acute appendicitis is one of the commonest causes of “Acute Surgical
Abdomen”. Even though the field of medicine has witnessed significant advancement in
radiological and laboratory investigations, none the less the diagnosis of Appendicitis
remains a dilemma. Experienced clinicians can accurately diagnose appendicitis based on a
combination of history, physical examination and laboratory studies in about 80% of the
cases. Delay in the diagnosis of Acute Appendicitis is likely to lead to perforation and
peritonitis and hence increased mortality and morbidity making it a double-edged sword.
Surgical delay in prompt management of the subjects with appendicitis leads to dreadful
complications like gangrenous changes and perforation of the appendix. Recently, rise in
level serum bilirubin has been reported in acute appendicitis and appendicular perforation,
but the importance of the raised total bilirubin has not been stressed. The present study was
undertaken to assess the relationship between hyperbilirubinemia and acute appendicitis or
appendicular perforation.
Material and methods: A total of 50 consecutive cases diagnosed as acute appendicitis and
appendicular perforation, based on clinical examination and various investigations, and
subjected to Open or Laparoscopic Appendicectomy, were studied. Pre-operatively, patient’s
blood was taken for estimating serum bilirubin, serum liver enzyme levels, total white blood
cell count and differential leukocyte count. Diagnosis of acute appendicitis or appendicular
perforation was correlated with levels of serum bilirubin.
Results: Level of Serum Bilirubin was raised in cases of acute appendicitis but much more in
appendicular perforation as compared to uncomplicated acute appendicitis.
Conclusion: Serum bilirubin levels appear to be a promising laboratory marker for
diagnosing acute appendicitis. Bilirubin levels come out to be a credible aid in diagnosis of
acute appendicitis and would be a helpful investigation in decision making
Key words: Acute Appendicitis, Appendicular Perforation, Serum Bilirubin
|
