Plasma total bilirubin levels in children with appendicitis admitted to the emergency department

Appendicitis is one of the most common reasons for emergency abdominal surgery in children. Appendicitis patients have complaints that are common with many conditions and diseases. Therefore, early and accurate diagnosis of acute appendicitis is important in avoiding morbidity and associated complications. The aim of this study was to investigate the importance of hyperbilirubinemia in both the diagnosis of acute appendicitis and in distinguishing the severity of appendicitis in children. This retrospective study included 242 patients, 118 of whom had surgery for appendicitis and 124 who were admitted with suspected appendicitis between January 2011 and February 2015. Age, gender, preoperative plasma total bilirubin levels and pathological examination reports from patients’ files were recorded. Patients with appendicitis were labelled as Group I. Patients with non-perforated appendicitis were in Group IA and patients with perforated appendicitis were in Group IB. Group II consisted of 124 patients who were hospitalized with suspected appendicitis but were discharged without an appendectomy. A statistically significant difference was observed between the two groups in terms of mean plasma total bilirubin levels (between group comparisons for Groups I and II, p = 0.007). According to the comparison of the subgroups with respect to the mean plasma total bilirubin levels, a statistically significant difference was not observed between subgroups IA and IB (p = 0.770).The present study indicates that plasma total bilirubin levels are not a reliable marker in either the diagnosis of appendicitis or the differentiation of perforated appendicitis from non-perforated appendicitis in children

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1. Rothrock SG, Pagane J. Acute appendicitis in children: Emergency department diagnosis and management. Ann Emerg Med. 2000;36(1):39- 51.

2. Marguerite L. Barrett, Anika L. Hines, Roxanne M. Andrews. Trends in Rates of Perforated Appendix, 2001–2010. HCUP Statistical Briefs. 2013;159:1-14.

3. Shawn D. Safford. Appendicitis. In: Mattei P, ed, Fundamentals of pediatric surgery, 2nd edition. New York: Springer, 2011;485-90.

4. Estrada JJ, Petrosyan M, Barnhart J, Tao M, Sohn H, Towfigh S, Mason RJ. Hyperbilirubinemia in appendicitis: A new predictor of perforation. J Gastrointest Surg. 2007;11(6):714-8.

5. Emmanuel A, Murchan P, Wilson I, Balfe P. The value of hyperbilirubinaemia in the diagnosis of acute appendicitis. Ann R Coll Surg Engl. 2011;93(3):213-7.

6. Atahan K, Üreyen O, Aslan E, Deniz M, Çökmez A, Gür S, Avci A, Tarcan E. Preoperative diagnostic role of hyperbilirubinaemia as a marker of appendix perforation. J Int Med Res. 2011;39(2):609-18.

7. Nomura S, Watanabe M, Komine O, Shioya T, Toyoda T, Bou H, Shibuya T, Suzuki H, Uchida E. Serum total bilirubin elevation is a predictor of the clinicopathological severity of acute appendicitis. Surg Today. 2014;44(6):1104-8.

8. Käser SA, Fankhauser G, Willi N, Maurer CA. C-reactive protein is superior to bilirubin for anticipation of perforation in acute appendicitis. Scand J Gastroenterol. 2010;45(7-8):885-92.

9. Sand M, Bechara FG, Holland-Letz T, Sand D, Mehnert G, Mann B. Diagnostic value of hyperbilirubinemia as a predictive factor for appendiceal perforation in acute appendicitis. Am J Surg. 2009;1988(2):193-8.

10. Noh H, Chang SJ, Han A. The diagnostic values of preoperative laboratory markers in children with complicated appendicitis. J Korean Surg Soc. 2012;83(4):237-41.

11. Khan S. Elevated serum bilirubin in acute appendicitis: a new diagnostic tool. Kathmandu Univ Med J. 2008;6(2):161-5.

12. McGowan DR, Sims HM, Zia K, Uheba M, Shaikh IA. The value of biochemical markers in predicting a perforation in acute appendicitis. ANZ J Surg. 2013;83(1-2):79-83.

13. Giordano S, Pääkkönen M, Salminen P, Grönroos JM. Elevated serum bilirubin in assessing the likelihood of perforation in acute appendicitis: a diagnostic meta-analysis. Int J Surg. 2013;11(9):795-800.

14. Burcharth J, Pommergaard HC, Rosenberg J, Gögenur I. Hyperbilirubinemia as a predictor for appendiceal perforation: a systematic review. Scand J Surg. 2013;102(2):55-60.

15. Sisson RG, Ahlvin RC, Harlow MC. Superficial mucosal ulceration and the pathogenesis of acute appendicitis. Am J Surg. 1971;122(3):378- 80.

16. Rink RD, Kaelin CR, Giammara B, Fry DE. Effects of live Escherichia coli and Bacteroides fragilis on metabolism and hepatic PO2. Circ Shock. 1981;8(5):601-11.

17. Shander A. Anemia in the critically ill. Crit Care Clin. 2004;20(2):159-78.

18. Franson TR, Hierholzer WJ Jr, LaBrecque DR. Frequency and characteristics of hyperbilirubinemia associated with bacteremia. Rev Infect Dis. 1985;7(1):1-9.

19. Bennion RS, Thompson JE, Baron EJ, Finegold SM. Gangrenous and perforated appendicitis with peritonitis: treatment and bacteriology. Clin Ther. 1990;12 Suppl C:31-44.

20.Janssens AC, Moonesinghe R, Yang Q, Steyerberg EW, van Duijn CM, Khoury MJ. The impact of genotype frequencies on the clinical validity of genomic profiling for predicting common chronic diseases. Genet Med. 2007;9(8):528-35.

21. Jakobsdottir J, Gorin MB, Conley YP, Ferrell RE, Weeks DE. Interpretation of genetic association studies: markers with replicated highly significant odds ratios may be poor classifiers. PLoS Genet. 2009;5(2):e1000337.
Medicine Science-Cover
  • ISSN: 2147-0634
  • Yayın Aralığı: Yılda 4 Sayı
  • Başlangıç: 2012
  • Yayıncı: Effect Publishing Agency ( EPA )