Role of Hyperbilirubinemia as a Predictor in case of Ruptured or Gangrenous Appendicitis

Acute appendicitis is one of the commonest causes for acute abdomen that requires surgical treatment. It may cause dire complications like ruptured or gangrenous appendicitis [RGA]. This study was aimed to find whether serum total bilirubin [STB] can be used as a new pre-operative laboratory marker to aid in the diagnosis of RGA in acute appendicitis and also to find the significance if any for RIPASA and modified Alvarado scoring system [MASS] in the same. This was a case series analysis in 150 patients admitted with right iliac fossa [RIF] pain. MASS and RIPASA scores were given and STB investigated for all patients. Further treatment was planned according to the surgeon’s discretion taking into consideration the RIPASA scoring category of each patient. Post-operatively all appendix specimen were send for histopathological examination (HPE). Intra-operative diagnosis and post-operative HPE reports were taken to diagnose RGA. Further the STB values were correlated with occurrence of RGA to find any statistically significant relation between hyperbilirubinemia and RGA. A total of 150 patients were analyzed on accrual and mean STB value 1.20 mg/dl SD1.50. The mean STB values of 121 patients who were diagnosed to have appendicitis were 1.36 mg/dl SD1.62. Of these, 33 had RGA, while 88 did not. The STB values of the patients with acute appendicitis and not RGA had a mean value of 0.61 mg/dl SD0.34, while patients with RGA had a mean value of 3.37 mg/dl SD1.95. According to the present study, a STB value above 1.75 mg/dl in a patient with RIF pain has high probability to have RGA. RIPASA and MASS values could not be significantly correlated with RGA, thereby increasing the importance of serum total bilirubin as a new pre-operative laboratory marker to aid in the early diagnosis of ruptured or gangrenous appendicitis in acute appendicitis.