LOS ANGELES — Elevated serum bilirubin on admission may be a tip-off to a perforated appendix, according to research from the University of Southern California, Los Angeles, that was prsesented at the annual Digestive Disease Week.
Dr. Joaquin Estrada and his associates in the department of surgery at the university reported that those patients who had a gangrenous and/or perforated appendix were 2.9 times more likely than were other patients with suspected appendicitis to have a total bilirubin greater than 1 mg/dL upon admission.
The team retrospectively reviewed the charts of 41 patients who were found to have a gangrenous/perforated appendix at surgery.
Dr. Estrada and his colleageus also looked at a total of 116 patients who had been admitted for suspected acute appendicitis but who were not found to have a perforated or gangrenous appendix.
A pathologically normal appendix was found in 13 of the patients in the latter group.
Among those patients with perforation, a total of 23, or 56%, were found to have had an elevated bilirubin upon admission compared with 36, or 31% of those who were not found to have a perforated or gangrenous appendix.
There were several factors that did not distinguish the two groups. These factors included the duration of symptoms, the total white blood count, elevated temperature, systemic inflammatory response score, and patient age.
While larger studies are needed, Dr. Estrada said that these findings may help to assist clinicians “in determining which patients you'd like to get a CT scan on.”
A potential mechanism for raising bilirubin, based on animal studies, is a biochemical response to bacteremia, Dr Estrada said.
Patients were not included in the 12-month review of cases if they had liver disease, alcoholism, hemolytic disorders, or biliary disease.