Serum Bilirubin as a New Diagnostic Marker for Appendicitis and Appendicular Perforation—a Case Series Analysis

One of the most performed emergency abdominal surgeries is appendicectomy. Studies show that serum bilirubin is raised in acute appendicitis and appendicular perforation, the significance of which has not been stressed. The purpose of the study is to find the relation between them. To study the relationship between hyperbilirubinemia and acute appendicitis; and to evaluate its credibility as a diagnostic marker for acute appendicitis and perforation. Case series analysis. This study was conducted in a tertiary hospital S.C.B. Medical College, Cuttack from October 2019 to October 2021. One hundred-fifty patients with clinical diagnosis acute appendicitis or appendicular perforation were randomly sampled. Serum bilirubin and liver function tests were carried out in the patients opting for the study. The mean total serum bilirubin was 1.771 SD0.92mg/dl which was above >1.0 mg/dl representing hyperbilirubinemia. Amongst the 117 patients diagnosed with acute appendicitis, 74 patients (63.24%) were found to have elevated bilirubin (mean 1.49 SD0.63 mg/dl) whereas in patients diagnosed with appendicular perforation (n = 33), 28 patients (84.8%) had bilirubin elevated (mean 2.77 SD1.08 mg/dl). The cut-off value of serum bilirubin was found to be 2.15 mg/dl above which complications occur. The sensitivity and specificity of bilirubin in diagnosing acute appendicitis and appendicular perforation were 71.96% and 38.88% respectively. The p-value is 0.001 suggesting a positive correlation. Serum bilirubin can be a useful investigation as it can be done easily and is less expensive. Patients with raised bilirubin of three or more times the normal bilirubin value and clinical signs of appendicitis and appendicular perforation have a higher probability of having complicated appendicitis on histopathological report.