Evaluation of the role of hyperbilirubinemia in the diagnosis of complicated appendicitis

Early and precise diagnosis of complicated appendicitis (gangrene، perforation، …) and proper surgical measures are necessary to prevent mortality and morbidity. The aim of this study was to investigate the diagnostic value of serum bilirubin level as a preoperative laboratory marker in the diagnosis of complicated appendicitis.

We evaluated 295 patients with primary diagnosis of acute appendicitis in Shahid Rajaee Hospital in Qazvin City. Demographic information، pain duration and other clinical findings such as fever and history of liver disease and the findings of physical examination were recorded in a predefined questionnaire. Then CBC diff. and serum total bilirubin of the patients were checked and macroscopic findings of appendix in the operating room and final pathologic diagnosis were also entered on the questionnaire.

Appendicitis was more frequent in the patients between 15 and 20 years of age (42. 7% of the patients). The mean age of patients was 30. 35 years old، 60% were male and 40% female. Leukocytosis and shift to the left were detected in 98. 5% of the patients with complicated appendicitis and 85. 6% of the cases without any complications which showed a significant difference (P<0. 001). The serum bilirubin level was significantly higher in the patients with complicated appendicitis (P<0. 01).

This study showed that patients with clinical symptoms of appendicitis and hyperbilirubinemia were more likely to develop complications in comparison to the patients with normal bilirubin level. Therefore، measurement of serum bilirubin level together with WBC count can be helpful for assessment and diagnosis of complicated appendicitis.