Evaluation of Serum Bilirubin as a Predictive Marker for Simple and Complicated Appendicitis in Sulaimani Emergency Teaching Hospital

Abstract = 794 times | PDF = 175 times

Main Article Content

Seerwan Hama Shareef Dara Ahmed Mohammed Goran Ameer Ahmed

Abstract

Diagnosis of acute appendicitis can be challenging in some cases as the differentials can be exhaustive. Previous studies have demonstrated that hyperbilirubinemia is a more specific marker for appendicitis than white blood count (WBC) and C-reactive protein (CRP), but this investigation is still not commonly used in the diagnostic workup of appendicitis. This prospective study aims to evaluate serum bilirubin as a laboratory marker for simple and complicated appendicitis. We also investigated the diagnostic value of bilirubin in acute appendicitis and compared it with the WBC. In this prospective study, all patients who underwent appendicectomy at the Sulaimani Emergency Teaching Hospital between 1st November 2016 to 1st January 2017 were included. Preoperative total serum bilirubin was measured and compared with the final histopathology report. Patients were divided into 3 groups: non-inflamed appendix, simple appendicitis and complicated appendicitis. One hundred and 75 patients were analysed, 90 of them were females and 85 were males. Hyperbilirubinemia was found in 63% of patients with complicated appendicitis (p=0.001). Mean of bilirubin was significantly different between patients with complicated appendicitis and non-complicated appendicitis (1.101 vs 0.75 mg/dl; p= 0.0017). Bilirubin had a higher specificity (85%) than WBC (36%), but a lower sensitivity (63% vs 89%) for differentiating complicated appendicitis. Patients with suggestive features of acute appendicitis and raised serum bilirubin indicate a complicated case requiring early intervention to prevent peritonitis and septicaemia. Hyperbilirubinemia is a good indicator for complicated appendicitis and serum bilirubin measurement can be included in the work up of patients with suspected appendicitis.                       

Keywords

Acute appendicitis, Appendectomy, Hyperbilirubinaemia, Diagnostic markers.

Downloads

Download data is not yet available.

Article Details

References

[1] A, Cusheiri, PA, Grace, A, “Darzi, et al. Disorders of small intestine and vermiform” appendix. In: Cuschieri A, Grace PA, Darzi A, et al, editors. Clinical Surgery. 2nd ed. UK: Blackwell Publishing Ltd; 2003;405.
[2] S. Paterson – Brown. “Acute appendicitis. In: Paterson-Grown Simon, Ellis Brian W, Paterson-Brown Simon, editors. Hamilton Bailey’s Emergency Surgery. 13th ed. London: Arnold; 2003, 399.
[3] Smith PH. The diagnosis of appendicitis. Postgrad Med J 1965, pp. (4) 2-5.
[4] WH, Peranteau, DS, Smink. Appendix, Meckel’s and other small bowel diverticula. In: Zinner M, Ashley S., editors. Maingot's Abdominal Operations. 12th Edition. USA: McGraw-Hill Professional. 2012, pp. 623-40
[5] BM, Jaffe. DH, Berger. The Appendix. In: Brunicardi FC, et al. editors. Schwartz’s principles of surgery. 9th ed. USA: McGrawHill. 2010, pp.1073-1089
[6] A, Cuschieri. Disorders of the small intestine and vermiform appendix. In: Cuschieri A, Hanna GB, editors. Essential surgical practice: higher surgical training in general surgery. 5th edition. UK: Crc Press.2015, pp. 927-30
[7] F, Nabipour. BD, Mohammad. Histopathological feature of acute appendicitis in Kerman–Iran from 1997 to 2003. Am J Environ Sci. 2005, pp1:130-2.
[8] YA, Al-Abed. N, Alobaid. F, Myint “Diagnostic markers in acute appendicitis”. The American Journal of Surgery. 2015 Jun 30;209(6), pp.1043-7.
[9] R, Marudanayagam. GT, Williams. “Rees BI. Review of the pathological results of 2660 appendicectomy specimens”. Journal of gastroenterology. 2006 Sep 1;41(8), pp745-9.
[10] J, Maa. KS, .Kirkwood. “The Appendix. In: Townsend Jr CM, Beauchamp RD, Evers BM, Mattox KL. editors. Sabiston textbook of surgery”. 19th ed. USA: Elsevier Health Sciences.2012, pp.1279-93
[11] C, Franke. H, Bohner. Q,Yang. C, Ohmann. HD, Roher. “Ultrasonography for diagnosis of acute appendicitis: results of a prospective multicenter trial. Acute Abdominal Pain Study Group”. World J Surg 1999, pp.23:141-6.
[12] P, Poortman. PN, Lohle. CM, Schoemaker HJ, Oostvogel HJ, Teepen. KA, Zwinderman et al. “Comparison of CT and sonography in the diagnosis of acute appendicitis: a blinded prospective study”. AJR Am J Roentgenol 2003, pp181-186.
[13] S, Cakirer. M, Basak. B, Colakoglu. M, Bankaoglu “Diagnosis of acute appendicitis with unenhanced helical CT: a study of 130 patients”. Emerg Radiol 2002(9), pp155-156
[14] MJ, Lane. DM, Liu. Huynh MD, Jeffrey RB Jr, Mindelzun RE, Katz DS. Suspected acute appendicitis: nonenhanced helical CT in 300 consecutive patients. Radiology 1999; 213:341-6.
[15] PF, Jones. “Suspected acute appendicitis: trends in management over 30 years” British journal of surgery. 2001 Dec 1;88(12), pp.1570-1577.
[16] A, Alvarado”A practical score for the early diagnosis of acute appendicitis” Ann Emerg Med 1986(15), pp557-564.
[17] CD, Douglas”Macpherson NE, Davidson PM, Gani JS. Randomised controlled trial of ultrasonography in diagnosis of acute appendicitis, incorporating the Alvarado score” BMJ 2000(321), pp919-922.
[18] TD, Owen” Williams H, Stiff G, Jenkinson LR, Rees BI. Evaluation of the Alvarado score in acute appendicitis” J R Soc Med 1992(85), pp.87-88.
[19] MJ, Lamparelli. HM, Hoque, CJ, Pogson “Ball AB. A prospective evaluation of the combined use of the modified Alvarado score with selective laparoscopy in adult females in the management of suspected appendicitis” Ann R Coll Surg Engl 2000(82), pp.192-195.
[20] SM, de Castro, C, Unlu. EP, Steller “van Wagensveld BA, Vrouenraets BC. Evaluation of the appendicitis inflammatory response score for patients with acute appendicitis” World J Surg 2012(36), pp.1540-1545.
[21] M, Andersson. RE, Andersson “The appendicitis inflammatory response score: a tool for the diagnosis of acute appendicitis that outperforms the Alvarado score” World J Surg 2008 (32), pp.1843-1849.
[22] R, Ohle. F, O’Reilly. KK, O’Brien. T, Fahey. BD, Dimitrov.”The Alvarado score for predicting acute appendicitis: a systematic review” BMC Med 2011(9), pp.139-143
[23] YR, Hong Chung, JW, Kim. CI, Kwon. DH, Ahn, SW, Kwon., SK, Kim. “Hyperbilirubinemia is a significant indicator for the severity of acute appendicitis. Journal of the Korean Society of Coloproctology”. 2012, (5), pp. 247-252.
[24] B, Vermeulen, A, Morabia, PF, Unger. “Influence of white cell count on surgical decision making in patients with abdominal pain in the right lower quadrant” The European journal of surgery= Acta chirurgica. 1995 (7), pp. 483-486.
[25] D, Birchley. “Patients with clinical acute appendicitis should have pre-operative full blood count and C-reactive protein assays. The Annals of The Royal College of Surgeons of England”. 2006, (1), pp.27-32.
[26] H, Körner, JA, Söreide, K, Söndenaa. “Diagnostic accuracy of inflammatory markers in patients operated on for suspected acute appendicitis: a receiver operating characteristic curve analysis. The European journal of surgery”. 1999 165(7), pp.679-685.
[27] PG, Vaughan-Shaw, JR, Rees, E, Bell, M, Hamdan, T, Platt “Normal inflammatory markers in appendicitis: evidence from two independent cohort studies”JRSM short reports. 2011 May 2(5), pp. 43-45.
[28] RE, Andersson. “Meta‐analysis of the clinical and laboratory diagnosis of appendicitis” British Journal of Surgery. 2004 91(1), pp. 28-37.
[29] A, Emmanuel, P, Murchan, I, Wilson, P, Balfe. “The value of hyperbilirubinaemia in the diagnosis of acute appendicitis” Annals of the Royal College of Surgeons of England. 2011;93(3), pp. 213-215.
[30] TA, Ogilvie. “Acholuric jaundice and appendicitis” Br J Surg 1951(38), pp. 529–530
[31] DF, Miller, RW, Irvine. Jaundice in acute appendicitis. Lancet 1969(1), pp. 321–323.
[32] S, Khan.”Elevated serum bilirubin in acute appendicitis: a new diagnostic tool” Kathmandu University Medical Journal. 2008(6), pp.161–5.
[33] JJ, Estrada, M, Petrosyan, J, Barnhart, M, Tao, H, Sohn, S, Towfigh, RJ, Mason. “Hyperbilirubinemia in appendicitis: a new predictor of perforation” Journal of Gastrointestinal Surgery. 2007 11(6), pp.714-718.
[34] M, Sand. FG, Bechara, T, Holland-Letz, D, Sand, G, Mehnert, B, Mann.”Diagnostic value of hyperbilirubinemia as a predictive factor for appendiceal perforation in acute appendicitis”. The American Journal of Surgery. 2009 198(2), pp.193-198.
[35] K, Atahan, O, Üreyen, E, Aslan, M, Deniz, A, Çökmez, S, Gür, A, Avci, E, Tarcan. “Preoperative diagnostic role of hyperbilirubinaemia as a marker of appendix perforation” Journal of International Medical Research. 2011 39(2), pp.609-618
[36] DR, McGowan, HM, Sims, I, Shaikh, M, Uheba. “The value of hyperbilirubinaemia in the diagnosis of acute appendicitis”. Annals of the Royal College of Surgeons of England. 2011 93(6), pp. 498.
[37] P, Chaudhary, A, Kumar, N, Saxena, UC, Biswal. “Hyperbilirubinemia as a predictor of gangrenous/perforated appendicitis: a prospective study. Annals of gastroenterology” quarterly publication of the Hellenic Society of Gastroenterology. 2013 (4), pp325
[38] N, D'Souza, D, Karim, R, Sunthareswaran. “Bilirubin; a diagnostic marker for appendicitis”. International Journal of Surgery. 2013 11(10), pp.11 -14
[39] AC, Chambers, SL, Bismohun, H, Davies, AV, White P, Patil. “Predictive value of abnormally raised serum bilirubin in acute appendicitis: a cohort study” International Journal of Surgery. 2015 (13), pp. 207-210
[40] EJ, Baron, R, Bennion, J, Thompson, C, Strong, P, Summanen, M, McTeague, SM, Finegold. “A microbiological comparison between acute and complicated appendicitis” Clinical Infectious Diseases. 1992 14(1), pp. 227-231.
[41] RD, Rink, CR, Kaelin, B, Giammara, DE, Fry. “Effects of live Escherichia coli and Bacteroides fragilis on metabolism and hepatic pO2. Circulatory shock”. 1980 (5), pp. 601-611.
[42] RM, Green, DA, Beier, JL, Gollan. ’”Regulation of hepatocyte bile salt transporters by endotoxin and inflammatory cytokines in rodents” Gastroenterology. 1996 111(1), pp. 193-198
[43] R, Utili, CO, Abernathy, HJ, Zimmerman. “Cholestatic effects of Escherichia coli endotoxin endotoxin on the isolated perfused rat liver. Gastroenterology” 1976 70(2), pp.248-253
[44] A, Shander. “Anemia in the critically ill” Crit Care Clin 2004(20), pp. 159 –178.
[45] J, Rosai. Gatrointestinal tract. In: J Rosai, LV Ackerman, editors. Rosai and Ackerman’s surgical pathology. 9th ed. Edinburgh: Mosby Co.2004, pp.757-61
[46] JM, Crawford, V, Kumar. The oral cavity and the gastrointestinal tract. In V, Kumar., RS, Cotran, and Robbins SL editors. Robbins Basic Pathology, 7th ed. New York: Saunders. 2003, pp. 588-9.
[47] A, Bhangu.” Safety of short, in-hospital delays before surgery for acute appendicitis: multicentre cohort study, systematic review, and meta-analysis”. Annals of surgery. 2014. (5), pp. 894-903.
[48] KK, Varadhan, DJ, Humes, KR, Neal, DN, Lobo. “Antibiotic therapy versus appendectomy for acute appendicitis: a meta-analysis” World journal of surgery. 2010, 34(2), pp. 199-209
[49] J, Hansson, U, Körner, A, Khorram‐Manesh, A, Solberg, K, Lundholm. “Randomized clinical trial of antibiotic therapy versus appendicectomy as primary treatment of acute appendicitis in unselected patients” British journal of surgery. 2009, 96(5), pp. 473-81
[50] S, Eriksson, L, Granström. “Randomized controlled trial of appendicectomy versus antibiotic therapy for acute appendicitis” British journal of surgery. 1995, 82(2), pp. 166-169
[51] J, Styrud, S, Eriksson, I, Nilsson, G, Ahlberg, S, Haapaniemi, G, Neovius, L, Rex, I, Badume, L, Granström. “Appendectomy versus antibiotic treatment in acute appendicitis. a prospective multicenter randomized controlled trial” World journal of surgery. 2006, 30(6), pp.1033-1037.
[52] N, Chand, AJ, Sanyal. “Sepsis‐induced cholestasis. Hepatology” 2007, 45(1), pp. 230-241.
[53] IG, Panagiotopoulou, D, Parashar, R, Lin, S, Antonowicz, AD, Wells, FM, Bajwa, B, Krijgsman. “The diagnostic value of white cell count, C-reactive protein and bilirubin in acute appendicitis and its complications” The Annals of the Royal College of Surgeons of England. 2013 95(3), pp. 215-221.