Elevated serum bilirubin in acute appendicitis :a new diagnostic tool.
BACKGROUND
Acute appendicitis (AA) is one of the most common intra abdominal affections seen in surgical department,which can be treated easily if accurate diagnosis is made in time, otherwise delay in diagnosis and treatment can lead to gangrene perforation and diffuse peritonitis.


OBJECTIVE
Of the study was to determine the role and predictive value of elevated total serum bilirubin(TSB) in the diagnosis of AA.


METHODS
All the patients admitted with clinical diagnosis of AA were tested by laboratory investigations and ultrasonography of the abdomen. Preoperatively patient's blood was also collected for serum bilirubin and other liver enzymes estimation. Cases that underwent emergency appendicectomy from January 2004-May 2007 were included in present study.


RESULTS
All the patients presented within 5 hours to 7 days of onset of pain. Out of 110 patients studied, 71(64.54%)were males and 39(35.45%) were females. Age distribution was between 6 years to 73 years with a mean of 29.5 years. Out off 110 cases, 106 cases had AA (positive cases). Among 106 positive cases, TSB was elevated in 87(82.07%) cases.The mean of elevated TSB was 2.26 mg/dL, ranged 1.2-11.5 mg/dL. An interesting finding was observed that patient's in whom the appendix was gangrenous or perforated; elevation of TSB was found to be higher as compared to simple suppurative AA. The specificity, sensitivity was 100%, 82.07%, respectively with predictive value of positive test 100%and predictive value of negative test 17.3%. The liver enzymes were either normal or marginally elevated (<1 time) in most of the cases (Fig.1, 2, 3).


CONCLUSIONS
It was found in our study that elevated TSB (without severe abnormalities in the value of liver enzymes)is good indicator of AA. The specificity and sensitivity of elevated TSB was 100% and 82.07% respectively with a predictive value for positive test 100%. If TSB is added to already existing laboratory tests, then the diagnosis of AA in clinically suspected cases can be made with fair degree of accuracy and unnecessary or delay in appendicectomy can be avoided
Khan
S
S
Department of surgery, Nepalgunj Medical College, Nepalgunj, Nepal. drsalamatkhan63@yahoo.co.uk