Abstract
Background: The physiological obstruction of the bile flow associated with appendicular pathology leads to hyperbilirubinemia, which can be used as a predictive factor of appendicular perforation.
Objective/Aim: Primary objective of this study was
1. To evaluate hyper-bilirubinemia associated with appendicular pathology.
The secondary objectives of this study were
1. To evaluate elevated bilirubin level as an additional diagnostic marker for
the severity of acute appendicitis.
2. To evaluate whether elevated bilirubin levels have a predictive potential
for the diagnosis of appendicular perforation.
Methods: The study was conducted in the department of Surgery, Central Referral Hospital, associated with Sikkim Manipal Institute of Medical Sciences, Gangtok. The study was designed as a prospective observational study spanning 12 months, with an enrolment of patients from 12.05.2016 to 11.05.2017. A total of 52 patients with clinical diagnoses of features of acute appendicitis or appendicular perforation admitted to the surgical ward were included.
Results: Patients with appendicular perforation (n=14) were divided based on the location of perforation:9(64.3%) had perforation at the apex, 2(14.3%) at the base and 3 (21.4%) had perforation at the body of appendix. Patients with perforation at the apex of the appendix had mean total bilirubin of 1.84 mg/dl; 7 (77.8%) of these patients had elevated total bilirubin, while an equal number had elevated direct bilirubin. Two (22.2%) had normal total bilirubin and value. Patients with perforation at the base had mean total bilirubin of 1.11 mg/dl and direct bilirubin of 0.56 mg/dl. Though one had elevated total bilirubin, the other had a normal value.
On the other hand, both had elevated direct bilirubin. The patients having perforation on the body of the appendix had mean total bilirubin and direct bilirubin of 1.51 mg/dl and 0.57 mg/dl, respectively. Both these patients had elevated total bilirubin and direct bilirubin. It was found that both total and direct bilirubin increased in cases having perforation of the appendix, but these elevations were not statistically significant.
Conclusions: Based on the data obtained, the bilirubin levels cannot be used as an indicator for:
a) Severity of acute appendicitis
b) appendicular perforation.

Key words: acute appendicitis, appendicular perforation, hyperbilirubinemia