Hyperbilirubinemia in Appendicitis: A New Predictor of Perforation
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
This study examines the relationship between hyperbilirubinemia and appendicitis. It was hypothesized that an association exists between the presence of appendiceal perforation and hyperbilirubinemia. Patients with liver function tests on admission and pathologically confirmed appendicitis were included in the study. Age, duration of symptoms, temperature, white blood cell counts, systemic inflammatory response score, and bilirubin levels were independent variables in a logistic regression analysis assessing factors predicting the presence or absence of appendiceal gangrene/perforation. Elevated total bilirubin levels (>1 mg/dl) were found in 59 (38%) of 157 patients. Patients with gangrene/perforation were significantly (p = 0.004) more likely to have hyperbilirubinemia than those with acute suppurative appendicitis. No statistical differences were observed for any of the other variables. On logistic regression the only significant relationship between the presence or absence of appendiceal gangrene and perforation was the presence of hyperbilirubinemia (p = 0.031, 95% confidence interval 1.11–7.6). The odds of appendiceal perforation are three times higher (odds ratio 2.96) for patients with hyperbilirubinemia compared to those with normal bilirubin levels. Hyperbilirubinemia is frequently associated with appendicitis. Elevated bilirubin levels have a predictive potential for the diagnosis of appendiceal perforation.
- [No authors listed]. Jaundice due to bacterial infection. Gastroenterology 1979;77(2):362–374.
- Johnson AM. Sepsis and jaundice. Pediatrics 1993;91(5):1018.
- Miller DJ, Keeton DG, Webber BL, Pathol FF, Saunders SJ. Jaundice in severe bacterial infection. Gastroenterology 1976;71(1):94–97.
- Whitehead MW, Hainsworth I, Kingham JG. The causes of obvious jaundice in South West Wales: perceptions versus reality. Gut 2001;48(3):409–413. CrossRef
- Chavalitdhamrong PO, Escobedo MB, Barton LL, Zarkowsky H, Marshall RE. Hyperbilirubinaemia and bacterial infection in the newborn. A prospective study. Arch Dis Child 1975;50(8):652–654.
- Goldberg PK, Kozinn PJ, Kodsi B, et al. Endotoxemia and hyperbilirubinemia in the neonate. Am J Dis Child 1982;136(9):845–848.
- Johnson AO, Nottidge VA, Ojo CO, Junaid TA, Akingbehin NA, Attah EB. Conjugated hyperbilirubinaemia in Nigerian infants. Afr J Med Sci 1980;9(3–4):117–127.
- Kumari S, Bhatnagar S, Khanna C, Sethi T, Mullick DN. Neonatal jaundice: association with neonatal septicemia. Indian Pediatr 1987;24(5):433–435.
- Franson TR, Hierholzer WJ, Jr., LaBrecque DR. Frequency and characteristics of hyperbilirubinemia associated with bacteremia. Rev Infect Dis 1985;7(1):1–9.
- Ogilvie TA. Acholuric jaundice and appendicitis. Br J Surg 1951;38(152):529–530. CrossRef
- Eley A, Hargreaves T, Lambert HP. Jaundice in Severe Infections. Br Med J 1965;5453:75–77. CrossRef
- Miller DF, Irvine RW. Jaundice in acute appendicitis. Lancet 1969;1(7590):321–323. CrossRef
- Seller RA. Jaundice in acute appendicitis. Lancet 1969;1(7599):838. CrossRef
- Ermich S, Kantor Z. Jaundice in the course of acute appendicitis. Pol Tyg Lek 1970;25(42):1583–1584.
- Meyer G, Landi JP, Pitchumont CS. Acute appendicitis presenting as cholestatic jaundice. N Y State J Med 1984;84(3 Pt 1):131–132.
- Lotveit T. Acute appendicitis in patients with Gilbert’s syndrome. Acta Chir Scand 1985;151(8):701–702.
- Utili R, Abernathy CO, Zimmerman HJ. Cholestatic effects of Escherichia coli endotoxin on the isolated perfused rat liver. Gastroenterology 1976;70(2):248–253.
- Utili R, Abernathy CO, Zimmerman HJ. Studies on the effects of C. coli endotoxin on canalicular bile formation in the isolated perfused rat liver. J Lab Clin Med 1977;89(3):471–482.
- Utili R, Abernathy CO, Zimmerman HJ. Endotoxin effects on the liver. Life Sci 1977;20(4):553–568. CrossRef
- Sisson RG, Ahlvin RC, Harlow MC. Superficial mucosal ulceration and the pathogenesis of acute appendicitis. Am J Surg 1971;122(3):378–380. CrossRef
- Bennion RS, Wilson SE, Serota AI, Williams RA. The role of gastrointestinal microflora in the pathogenesis of complications of mesenteric ischemia. Rev Infect Dis 1984;6(Suppl 1):S132–S138.
- Bennion RS, Wilson SE, Williams RA. Early portal anaerobic bacteremia in mesenteric ischemia. Arch Surg 1984;119(2):151–155.
- Bennion RS, Baron EJ, Thompson JE, Jr., et al. The bacteriology of gangrenous and perforated appendicitis–revisited. Ann Surg 1990;211(2):165–171. CrossRef
- Bennion RS, Thompson JE, Baron EJ, Finegold SM. Gangrenous and perforated appendicitis with peritonitis: treatment and bacteriology. Clin Ther 1990;12(Suppl C):31–44.
- Oliak D, Yamini D, Udani VM, et al. Can perforated appendicitis be diagnosed preoperatively based on admission factors? J Gastrointest Surg 2000;4(5):470–474. CrossRef
- Hyperbilirubinemia in Appendicitis: A New Predictor of Perforation
Journal of Gastrointestinal Surgery
Volume 11, Issue 6 , pp 714-718
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Industry Sectors
- Author Affiliations
- 1. Division of Emergency (Non-Trauma) Surgery, Department of Surgery, Keck School of Medicine of the University of Southern California and Los Angeles County, USC Medical Center, 1200 North State Street, Room 10-850, Los Angeles, CA, 90033, USA