Top

European Journal of Trauma and Emergency Surgery

Published in:

01-04-2016 | Original Article

Hyperbilirubinaemia in appendicitis: the diagnostic value for prediction of appendicitis and appendiceal perforation

Authors: H. L. Adams, S. S. Jaunoo

Published in: European Journal of Trauma and Emergency Surgery | Issue 2/2016

Abstract

Aim

The aim of this study is to evaluate the diagnostic value of pre-operative bilirubin levels in the diagnosis of acute appendicitis and appendiceal perforation.

Method

A retrospective analysis of 557 patients undergoing emergency appendicectomy over a 24-month period at a large teaching hospital. Hyperbilirubinaemia was defined as >25 µmol/L. Data were analysed using descriptive statistics.

Results

484 of the 557 (86.9 %) operated cases were found histologically to be appendicitis. 116 cases of the 484 were perforated (24 %). Bilirubin levels were significantly higher in the group with appendicitis versus the group found to have a normal appendix at histology, [median (IQR) 12.0 µmol/L (9.00) vs. 8.0 µmol/L (7.00) respectively, p < 0.001], despite being within normal serum bilirubin range. Sensitivity of hyperbilirubinaemia for acute appendicitis was only 8 %, however specificity was 94 %. PPV was 85 % and NPV was 26 %. Whilst bilirubin was higher in patients with a perforated appendix versus acute appendicitis [median (IQR) 13.0 µmol/L (9.00) vs. 11.0 µmol/L (9.00), respectively], statistically, there was no significant difference in pre-operative bilirubin levels between the perforated appendicitis cases and the non-perforated appendicitis cases (p = 0.326). However, the specificity of hyperbilirubinaemia for perforated appendicitis was 93 %, sensitivity 9.4 %, PPV 24 % and NPV 82 %.

Conclusion

Bilirubin levels may be high, but remain within normal range, in cases of appendicitis. Therefore, bilirubin levels may be a useful measurement when investigating a patient with suspected appendicitis. Hyperbilirubinaemia is highly specific with regards to perforation, a finding supported by other studies. However, possibly because of the few perforated cases in this study, we cannot recommend that hyperbilirubinaemia be used to predict perforation.

Ozguner IF, Buyukayavuz BI, Savas MC. The influence of delay on perforation in childhood appendicitis. A retrospective analysis of 58 cases. Saudi Med J. 2004;25:1232–6.PubMed

Zhang Y, Zhao YY, Qiao J, et al. Diagnosis of appendicitis during pregnancy and peritoneal outcome in the late pregnancy. Chin Med J. 2009;122:521–4.PubMed

Khalil J, Muqim R, Rafique M, et al. Laparoscopic versus open appendectomy: a comparison of primary outcome measures. Saudi J Gastroenterol. 2011;17(4):236–40.CrossRefPubMedPubMedCentral

Fahim F, Shirjeel S. A comparison between presentation time and delay in surgery in simple and advanced appendicitis. J Ayub Med Coll Abbottabad. 2005;17:37–9.PubMed

Kumar B, Samad A, Khanzada TA, et al. Superiority of laparoscopic appendectomy over open appendectomy: the Hyderabad experience. Rawal Med J. 2008;33:165–8.

Khan S. The diagnostic value of hyperbilirubinemia and total leucocyte count in the evaluation of acute appendicitis. JCDR. 2009;3:1647–52.

De Dombal FT, Leaper DJ, Staniland JR, et al. Computer-aided diagnosis of acute abdominal pain. BMJ. 1972;2:9–13.CrossRefPubMedPubMedCentral

Deutsch A, Shani N, Reiss R. Are some appendectomies unnecessary: and analysis of 319 white appendices. JR Coll Surg Edinb. 1983;28:35–40.

Simmen HP, Decurtins M, Rotzer A, et al. Emergency room patients with abdominal pain unrelated to trauma: prospective analysis in a surgical university hospital. Hepatogastroenterology. 1991;38:279–82.PubMed

10.

Rao PM, Rhea JT, Novelline RA. Helical CT of appendicitis and diverticulitis. Radiol Clin North Am. 1999;37:895–910.CrossRefPubMed

11.

Atahan K, Ureyen O, Aslan E, et al. Preoperative diagnostic role of hyperbilirubinaemia as a marker of appendix perforation. J Int Med Res. 2011;39:609–18.CrossRefPubMed

12.

Carbonell AM, Burns JM, Lincourt AE, Harold KL. Outcomes of laparoscopic versus open appendectomy. Am Surg. 2004;70:759–66.PubMed

13.

Bennion RS, Wilson SE, Serota AI, et al. The role of gastrointestinal microflora in the pathogenesis of complications of mesenteric ischemia. Rev Infect Dis. 1984;6(Suppl 1):S132–8.CrossRefPubMed

14.

Bennion RS, Wilson SE, Williams RA. Early portal anaerobic bacteremia in mesenteric ischemia. Arch Surg. 1984;119(2):151–5.CrossRefPubMed

15.

Estrada JJ, Petrosyan M, Barnhart J, et al. Hyperbilirubinemia in appendicitis: a new predictor of perforation. J Gastrointest Surg. 2007;11:714–8.CrossRefPubMed

16.

Ghimire P, Thapa P, Yogi N, et al. Role of serum bilirubin as a marker of acute gangrenous appendicitis. NJMS. 2012;1(2):89–92.

17.

Ortega-Deballon P, Ruiz de Adana-Belbel JC, Hernandez-Matias A, et al. Usefulness of laboratory data in the management of right iliac fossa pain in adults. Dis Colon Rectum. 2008;51:1093–9.CrossRefPubMedPubMedCentral

18.

Gronroos JM, Gronroos P. Leucocyte count and C-reactive protein in the diagnosis of acute appendicitis. Br J Surg. 1999;86:501–4.CrossRefPubMed

19.

Sand M, Bechara FG, Holland-Letz T, et al. Diagnostic value of hyperbilirubinemia as a predictive factor for appendiceal perforation in acute appendicitis. Am J Surg. 2009;198:193–8.CrossRefPubMed

20.

Kaser SA, Frankhauser G, Willi N, et al. C reactive protein is superior to bilirubin for anticipation of perforation in acute appendicitis. Scand J Gastroenterol. 2010;45:885–92.CrossRefPubMed

21.

Emmanuel A, Murchan P, Wilson I, et al. The value of hyperbilirubinaemia in the diagnosis of acute appendicitis. Ann R Coll Surg Engl. 2011;93:213–7.CrossRefPubMedPubMedCentral

22.

Kim E, Subhas G, Mittal VK, et al. C-reactive protein estimation does not improve accuracy in the diagnosis of acute appendicitis in pediatric patients. Int J Surg. 2009;7:74–7.CrossRefPubMed

23.

Beltran MA, Mendez PE, Barrera RE, et al. Is hyperbilirubinaemia in appendicitis a better predictor of perforation than C-reactive protein?—a prospective study. Indian J Surg. 2009;71:265–72.CrossRefPubMedPubMedCentral

24.

Wu HP, Lin CY, Chang CF, et al. Predictive value of C-reactive protein at different cutoff levels in acute appendicitis. Am J Emerg Med. 2005;23:449–53.CrossRefPubMed

25.

Gronroos JM, Forsstrom JJ, Irjala K, et al. Phospholipase A2, C-reactive protein, and white blood cell count in the diagnosis of acute appendicitis. Clin Chem. 1994;40:1757–60.PubMed

26.

Flum DR, McClure TD, Morris A, Koepsell T. Misdiagnosis of appendicitis and the use of diagnostic imaging. J Am Coll Surg. 2005;201:933–9.CrossRefPubMed

27.

Lee SL, Walsh AJ, Ho HS. Computed tomography and ultrasonography do not improve and may delay the diagnosis and treatment of acute appendicitis. Arch Surg. 2001;136:556–62.CrossRefPubMed

Title: Hyperbilirubinaemia in appendicitis: the diagnostic value for prediction of appendicitis and appendiceal perforation
Authors: H. L. Adams
S. S. Jaunoo
Publication date: 01-04-2016
Publisher: Springer Berlin Heidelberg
Published in: European Journal of Trauma and Emergency Surgery / Issue 2/2016
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI: https://doi.org/10.1007/s00068-015-0540-x

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Hyperbilirubinaemia in appendicitis: the diagnostic value for prediction of appendicitis and appendiceal perforation

Abstract

Aim

Method

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Aim

Method

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 2/2016

Advancing clinician-performed sonography in the twenty-first century: building on the rich legacy of the twentieth century pioneers

Clinical results of treatment of garden type 1 and 2 femoral neck fractures in patients over 70-year old

Grade IV renal trauma management. A revision of the AAST renal injury grading scale is mandatory

Out of hospital point of care ultrasound: current use models and future directions

Secondary abdominal compartment syndrome after complicated traumatic lower extremity vascular injuries

Thorough debridement and immediate primary wound closure for animal bite injuries of the upper limbs