ABSTRACT
Background: Acute appendicitis is a common acute abdominal condition that all surgeons confront. The early detection of patients who could go in for complication is critical so that appropriate treatment can be initiated to reduce mortality. There is no pre-operative investigation which accurately point out the patients who are going to develop severe disease. Hence this prospective study was done to identify whether preoperative bilirubin level can predict the severity of the disease.Methods: The study was conducted in the Department of General Surgery, Sree Gokulam Medical College and Research Foundation, Venjaramoodu, Trivandrum on 100 consecutive patients who were clinically diagnosed as acute appendicitis. These patients were evaluated with Alvarado score. In addition, preoperative bilirubin level and liver enzymes were estimated. Ultrasound abdomen was done preoperatively routinely. After surgery histopathology was studied. The parameters which showed statistically significant results for predicting complications were analyzed.Results: In this prospective study on 100 consecutive patients, acute appendicitis was found more commonly in males, 57 (57%) cases than in females, 43 (43%) cases. Among the cases 56 were acute appendicitis, 13 perforated, 11 gangrenous and 20 suppurative appendicitis. In our study, there was significant correlation of preoperative hyperbilirubinemia with complications of appendicitis.Conclusions: Patients with appendicitis with elevated bilirubin levels have more chance for complications like perforation, gangrene and suppuration.
ABSTRACT
Background: This study was conducted to determine the effectiveness of hyperbililrubinemia as diagnostic tool to predict perforated appendicitis.Methods: Patients presenting to department of general surgery of SS Medical College and Hospital during the period from June 2017 to June 2019 with features of appendicitis and liver function tests on admission undergoing laparoscopic or open appendectomy were included in this study. Age, duration of symptoms, temperature, white blood cell counts, bilirubin levels and histological data were collected. Culture and sensitivity of peritoneal fluid was done. Patients were grouped according to histological examination of appendectomy specimens and comparison was made between the groups.Results: The mean bilirubin level of all patients was 0.95 mg/dl (range, 0.1-4.3 mg/dl). The mean bilirubin levels were higher for patients with simple appendicitis compared to those with a non-inflamed appendix (0.8 mg/dl and o.5 mg/dl, p<0.001). Hyperbilirubinaemia had a specificity of 88% and a positive predictive value of 88.89% for acute appendicitis. Patients with appendiceal perforation, however, had a mean bilirubin level of 1.5 mg/dl and were more likely to have hyperbilirubinaemia (p<0.001). The specificity of hyperbilirubinaemia for perforation or gangrene was 70%.Conclusions: patients with hyperbilirubinemia and clinical symptoms of appendicitis should be identified as having a higher probability of appendiceal perforation than those with normal bilirubin levels. Hyperbilirubinemia alone is not a strong enough predictor, but might be more useful when integrated into a scoring system.
ABSTRACT
Femoral hernias account for up to 4% of all hernias that occur in the inguinal region. The hernial sac usually contains the greater omentum, small intestine, large intestine and preperitoneal fat, but rarely, in only 0.8% of the all cases, it also contains the appendix. Femoral, inguinal and incisional hernias, combined with appendicitis, occur in only 0.13% of cases. Thus, the incidence of appendicitis associated with a femoral hernia would be expected to be very rare. Herein, a case of an incarcerated femoral hernia, including a gangrenous appendix, is reported. An 81-year-old female was admitted with a protruding mass in the right inguinal area of 2 days duration. On inspection, a 4x3 cm sized erythematous bulging mass was noted. On palpation, the mass was tender and fixed in nature. There were no signs of peritoneal irritation or other palpable masses in the whole abdomen. Under the impression of a femoral hernia, a manual reduction was attempted, but to no avail. An immotile edematous intestine was noted on ultrasonography, and fluid retention with decreased blood circulation was noted in the intestine, suggestive of incarceration. An emergency operation was performed, with an incision made through the right groin region, where an incarcerated femoral hernia, including a gangrenous appendix, was found. An appendectomy and McVay repair were performed. The patient was discharged after 5 days, without any complications.