Bilirubin; a diagnostic marker for appendicitis

Arad

Postgraduate Medical Journal

et al. 2016

Young female patients have highest risk of being falsely diagnosed with acute appendicitis and hence unnecessary surgery. Bilirubin and lipase exhibit no correlations with acute appendicitis. Combined interpretation of WCC or CRP abnormal results yields competitive sensitivity as CT. Hencewe would suggest that, under the appropriate clinical context, one can use both WCC and CRP as a simple tool to support the diagnosis of appendicitis. If both tests show normal results, we would highly recommend considering alternative diagnosis.

Section: Discussioncontrasting

confidence: 99%

“…This finding is contradictory to the suggestions of some previous studies 4 11 12 19 31. Furthermore, in the female >40 years old subgroup, no tests or combinations of tests successfully rejected the null hypothesis; this is likely a consequence of the small subset sample size (N=37).…”

Section: Discussioncontrasting

confidence: 92%

The clinical value of pathology tests and imaging study in the diagnosis of acute appendicitis

Arad

Postgraduate Medical Journal

et al. 2016

Eur J Trauma Emerg Surg

“…Although the comparisons of CRP, and total bilirubin levels between negative and positive appendectomy cases did not reveal statistical significance (p > 0.05), these parameters were significantly higher in the gangrenous/perforated appendicitis group than the other two groups of patients (p < 0.01, and p < 0.01, respectively Despite numerous studies evaluating the predictive role of total bilirubin levels for acute appendicitis cases [19][20][21][22][23][24][25], no studies investigating the significance of direct and indirect bilirubin levels for this subject have been detected in the literature so far. The assessment of direct bilirubin levels, which is considered to represent the novelty of our study, revealed significantly elevated values in patients with either acute non-complicated, or gangrenous/perforated appendicitis (p < 0.01).…”

Section: Discussionmentioning

confidence: 93%

“…D'Souza et al concluded that hyperbilirubinemia was associated with complicated appendicitis, and that elevated bilirubin levels had a higher specifity (82 %) than both WBC (34 %) and CRP (21 %), but a lower sensitivity (70 %, 80 %, and 95 %, respectively) for perforated appendicitis versus simple appendicitis (p < 0.01) [21]. In the present study, WBC count, NEU count, and NEU% were detected to be significantly higher in cases of acute appendicitis when compared to cases having undergone negative appendectomies revealing the diagnostic sensitivity of these parameters (p < 0.01).…”

Section: Discussionmentioning

confidence: 99%

Hyperbilirubinemia as a predictive factor in acute appendicitis

Eren

Tombalak

Özemir

et al. 2015

“…There is a reasonable body of evidence to suggest that leaving a macroscopically normal Our regression analysis identified a number of factors associated with normal appendicectomy, which have also been identified by others, including age, female sex, white cell count, C-reactive protein and serum bilirubin. 7,[14][15][16] It is likely that surgeons do not take this full range of parameters into account when confronted with the decision to remove a normal appendix. One study proposed a standardised decision making tool based on the macroscopic appearance of the appendix.…”

Section: Discussionmentioning

confidence: 99%

The morbidity of negative appendicectomy

Lee

Paavana

Mazari

et al. 2014

annals

INTRODUCTION The increased use of diagnostic laparoscopy for management of right iliac fossa pain may have lowered the threshold for removing normal appendices, particularly as there is a perception that this practice carries little additional morbidity. The aim of this retrospective audit was to determine the negative appendicectomy rate after laparoscopic appendicectomy (LA) in our busy district hospital, and to compare the relative incidence and severity of complications after removal of an inflamed or non-inflamed appendix. METHODS Adult patients who underwent LA in 2011-2012 were identified from theatre registers. Histology results were reviewed to differentiate between inflamed and normal appendices. Postoperative complications and events following discharge were identified via electronic patient records. Complication severity was stratified using the Clavien-Dindo classification. RESULTS Over 2 years, 467 LAs were performed, of which 143 (30.6%) were for normal appendices. Significantly more negative appendicectomies were performed in women (43%) than in men (17%) (p<0.0001). Complications were seen in 62 patients (13.3%). There was no significant difference between the complication rates for those who had an inflamed (16.6%) or non-inflamed (11.9%) appendix (p=0.141). Similarly, there was no difference in the severity of complications between these groups. Reoperation or invasive intervention was required after four negative appendicectomies (2.8%). CONCLUSIONS LA carries a similar morbidity regardless of whether the appendix is inflamed. Negative appendicectomy should not be undertaken routinely during laparoscopy for right iliac fossa pain.