Hyperbilirubinaemia in Predicting Perforated Appendices in Emergency Settings

Introduction: Appendicitis is the most common abdominal emergency worldwide. Many standard laboratory tests are used to diagnose appendicitis, but there are no specific indicators. Some studies suggested that hyperbilirubinaemia correlates with appendiceal perforation. The objective of this study is to review the bilirubin level in patients with acute appendicitis (non-perforated appendix) and in those with a perforated appendix, to assess the efficacy of using the bilirubin level to predict if patients will have a perforated appendix.

Patients and Methods: This is a retrospective study of 269 patients who had undergone appendectomy from June 2008 to September 2016 in King Abdul Aziz University Hospital. These cases were classified histologically as acute non-perforated appendicitis and perforated or gangrenous appendicitis. The bilirubin levels of the two groups were compared in terms of the mean, sensitivity, and specificity.

Results: Thirty-six out of 269 patients (13.4%) had perforated appendix; within this group, 23 patients (63.9%) had hyperbilirubinaemia with a mean of 21.38 μmol/l. The sensitivity and specificity of hyperbilirubinaemia in those with perforated appendicitis ere 63.88% and 81.1%, respectively.

Conclusions: Acute appendicitis is a clinical diagnosis, that must be supported by laboratory investigations. In addition to the clinical presentation and other laboratory investigations, the serum bilirubin level is an important indicator in predicting the presence of a perforated appendix.