LOS ANGELES — Elevated serum bilirubin on admission may be a tip-off to a perforated appendix, researchers from the University of Southern California, Los Angeles, suggested at the annual Digestive Disease Week.
Dr. Joaquin Estrada and associates in the department of surgery at the university reported that patients with 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 charts of 41 patients found to have a gangrenous/perforated appendix at surgery and 116 patients admitted for suspected acute appendicitis who were not found to have a perforated or gangrenous appendix. A pathologically normal appendix was found in 13 patients in the latter group.
Among patients with perforation, 23, or 56%, had an elevated bilirubin upon admission compared with 36, or 31%, of those not found to have a perforated or gangrenous appendix.
Factors that did not distinguish the two groups included the duration of symptoms, the total white blood count, elevated temperature, systemic inflammatory response score, and age.
Although larger studies are needed, Dr. Estrada said the findings may 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, he said.
Patients were not included in the 12-month review of cases if they had liver disease, alcoholism, hemolytic disorders, or biliary disease.