Hyperbilirubinaemia: its utility in non‐perforated appendicitis

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Acute appendicitis is one of the most commonly encountered surgical conditions with the lifetime risk of having appendicitis estimated at 7%.1 Simple acute appendicitis has a low mortality rate of 0.3% but increases to 5–6% when combined with factors such as extremes of age, pre‐existing comorbidities and appendix perforation.2 Local and systemic complications such as abdominal abscess formation, sepsis, peritonitis and small bowel obstruction can occur with delayed diagnosis and treatment of a perforated appendix.3
The diagnosis of appendicitis is made on clinical grounds in conjunction with imaging and blood investigations. There is no single clinical test or investigation that can reliably predict appendicitis. The diagnosis of appendicitis can be problematic in those who present with atypical symptoms (20–33%) and there is generally a low threshold for a diagnostic laparoscopy.4 The rate of negative appendicectomy has been estimated at 10–30% and is highest in females of reproductive age (28.7%).5 These figures suggest that there is room for improvement in the diagnosis of appendicitis to reduce the rate of unnecessary surgery and decrease costs to the health care system. There have been some recent studies that suggest that bilirubin, a cheap and simple biochemical test, is a positive predictor for appendiceal perforation and may be more specific than C‐reactive protein (CRP) and white cell count (WCC) in diagnosis of acute appendicitis.6
The aim of this study was to investigate the usefulness of bilirubin in the diagnosis of appendicitis and to assess its utility in differentiating simple versus complicated appendicitis.
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