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: Acute appendicitis is one of the most common abdominal surgical emergencies requiring accurate diagnosis. Itis characterized by obstruction of its lumen, leading to inflammation and finally perforation. To define its prognosis, choose anappropriate surgical procedure and to decide non-surgical treatment, the pre-operative diagnosis of perforated or non-perforatedappendicitis is very important.Aim of the Study: This study aims to analyze the diagnostic accuracy of computed tomography (CT) scan abdomen indifferentiating perforated from non-perforated appendicitis using histopathology as the final diagnosis.Materials and Methods: Aprospective, cross-sectional analytical study, wherein 85 patients diagnosed with acute appendicitisreferred to the radiological department for CT scan abdomen were included in the study. Patients aged between 15 and 70 yearswere included in the study. CT scan abdomen with and without contrast was performed on a Toshiba 64 Multislice CT scanner(Toshiba Medical Systems Corp., Tokyo, Japan) which was used for all the patients. All the CT scans were interpreted by the sameconsultant radiologists with a minimum of 5 years of experience. The radiological features for the diagnosis of non-perforatedacute appendicitis by CT were based on swollen appendix, thickened enhancing wall, and smudging of surrounding fat planes,whereas the radiological features for perforated appendicitis used were, with abscess formation, phlegmon, extraluminal air,extraluminal appendicolith, and focal defect in the appendicular wall. Histopathology of the specimen collected following surgerywas undertaken by the hospital consultant pathologist of more than 5-year experience.Observations and Results: Among the 85 patients included in this study for the analysis of CT scan abdomen features, therewere 57 (67.05%) males and 28 (32.94%) females with a male-to-female ratio of 2.03:1. The mean age of the patients was38.90 ± 6.70 years. The incidence of non-perforated appendicitis was 66/85 (77.64%) including males 44/85 (51.76%) andfemales 22/85 (25.88%). The incidence of perforated appendicitis was 19/85 (22.35%) and males were 12/85 (14.11%) and 7/85(8.23%) were female. Patients aged 15–45 years of both genders constituted to 63/85 (74.11%) of the total patients. Amongthese patients, presenting with non-perforated appendicitis was 51/85 (60%) and perforated appendicitis was 12/85 (14.11%).Conclusions: Multislice CT scan abdomen was considered as the modality of choice for acute appendicitis not only to confirmthe diagnosis but also it plays an important role in assessment of appendicular complication, particularly in the detection ofperforated appendix. Using one or more of the five radiological signs of CT scan abdomen to identify appendicular perforationraised the sensitivity significantly reaching 94.12%.
ABSTRACT
Background: Acute appendicitis is the most common cause of acute abdomen in young adults requiring Emergency Surgery. Diagnosing Acute Appendicitis clinically still remains a common surgical problem. Accurate diagnosis can be aided by additional testing or expectant management or both. These might delay surgery and lead to appendicular perforation with increased morbidity and hospital stay. The aim of the study: To study the incidence of hyperbilirubinemia in cases of acute appendicitis and its complications (Gangrenous/ Perforated). Materials and methods: This Prospective study was done in the Department of General Surgery, Madras Medical College and Rajiv Gandhi Government General Hospital in 2017. Patient admitted with clinical diagnosis of acute appendicitis or its complications (Perforated/ Gangrenous) in the Emergency. Final HPE was considered as a gold standard for diagnosing and categorizing patients as having Normal Appendix, Acute appendicitis and Acute appendicitis with Perforation/Gangrene. Results: Out of 246 cases of Acute appendicitis 42 Cases were Gangrenous/ Perforated Appendix (17.07%). Out of 42 cases of Gangrenous/ Perforated appendix maximum cases seen in the Age group 21-30 years (31%) and least seen in below 10 years (0.0%). Above 50 years no of cases of Gangrenous/ Perforated appendix were 3 (7.1%). Rebound tenderness predominantly present in cases of Gangrenous/ Perforated Appendicitis than Acute appendicitis cases and its statistically significant. Among 246 cases minimum age was 9 and the maximum age was 65 years and the mean age was 24 years. Mean Total leukocyte count was 12687 and Mean polymorph count was 75. Serum mean total T. Avvai, S. Nedunchezian. To study the role of hyperbilirubinemia as a marker of gangrenous/ perforated appendicitis. IAIM, 2019; 6(3): 272-277. Page 273 bilirubin was .92 and maximum was 2.4 Alvarado’s score maximum seen was 10 and least was 5 with mean about 7. Conclusion: Patients with clinical signs and symptoms of Acute appendicitis with raised serum bilirubin should be considered as having high predictive potential for Appendicular gangrene/ Perforation. Serum Bilirubin is an important adjunct in diagnosing the presence of Gangrenous/ Perforated Appendicitis along with other diagnostic aids.