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International Journal of Applied Research
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ISSN Print: 2394-7500, ISSN Online: 2394-5869, CODEN: IJARPF


International Journal of Applied Research

Vol. 7, Issue 7, Part B (2021)

Hyperbilirubinemia as a predictor of gangrenous/perforated appendicitis: A prospective study

Ashish Sagar Tyagi, DS Nirhale and Shivmurti Khandalkar
Background: Appendicitis is one of the commonest causes of abdominal pain requiring emergency surgery. Often, it is difficult to reach a proper diagnosis. There may not be classical symptoms and signs of appendicitis. Different clinical signs and symptoms always mimic the diagnosis of acute appendicitis, as there are a number of causes leading to pain in right iliac fossa particularly in female patients. Diagnosing acute appendicitis clinically still remains a common surgical problem. Accurate diagnosis can be aided by additional testing or expectant management or both. These might delay laparotomy and lead to appendiceal perforation with increased morbidity and hospital stay [1-2].
Hyperbilirubinemia is a new diagnostic tool for perforation of appendix. Hyperbilirubinemia is the result of imbalance between production and excretion of bilirubin by the liver. The present study has been designed to evaluate the association between hyperbilirubinemia in cases of Gangrenous/ perforated appendix.
Method: The study was done at our tertiary care centre in the department of General Surgery, Dr. D. Y. Patil. Medical College, Pimpri, Pune on attending OPD/IPD after due permission from the Institutional Ethics Committee and Review Board and after taking Written Informed Consent from the patients.
Inclusion criteria for the study was as follows: male or female cases of 15 years of age and above till the age of 75years with a prelim diagnosis of acute appendicitis posted for an appendectomy at of our hospital.
Exclusion criteria was as follow: Incidental appendectomy or for other indications; cases who were under 15 years of age; cases with a already radiologically diagnosed lump appendix; known documented history of ALD; any other liver or heamolytic disease which is associated with HB; known case of a GI or hepatopancreatobiliary malignancy.
Quantitative data is presented with the help of Mean and Standard deviation. Comparison among the study groups is done with the help of unpaired t test as per results of normality test. Qualitative data is presented with the help of frequency and percentage table. Association among the study groups is assessed with the help of Fisher test, student ‘t’ test and Chi-Square test. ‘p’ value less than 0.05 is taken as significant.
Results: The incidence of perforated/gangrenous appendix was 24% in our study. 75% patient with Gangrenous/perforated appendix had elevated bilirubin levels while10.5% with acute appendicitis had elevated bilirubin levels. a sensitivity of 72.22%, specificity of 85.71% while PPV and NPV were 92.86% and 54.55% respectively.
Conclusions: Total serum bilirubin levels as a part of Liver function test profile estimation has been a routinely used and is easily available, also an affordable test available in every laboratory. As our study suggest the rise in serum bilirubin levels were considerably higher in cases with perforation hence it has a clear differential along with predictive potential. With the aid of serum bilirubin levels as an indication of perforated appendix a prompt and planned and premeditated clinical management can be initiated.
Pages: 101-104  |  215 Views  6 Downloads
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How to cite this article:
Ashish Sagar Tyagi, DS Nirhale, Shivmurti Khandalkar. Hyperbilirubinemia as a predictor of gangrenous/perforated appendicitis: A prospective study. Int J Appl Res 2021;7(7):101-104.
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International Journal of Applied Research