Khan S
Department of surgery, Nepalgunj Medical College, Nepalgunj, Nepal.
Kathmandu Univ Med J (KUMJ). 2008 Apr-Jun;6(2):161-5.
Acute appendicitis (AA) is one of the most common intra abdominal affections seen in surgical department,which can be treated easily if accurate diagnosis is made in time, otherwise delay in diagnosis and treatment can lead to gangrene perforation and diffuse peritonitis.
Of the study was to determine the role and predictive value of elevated total serum bilirubin(TSB) in the diagnosis of AA.
All the patients admitted with clinical diagnosis of AA were tested by laboratory investigations and ultrasonography of the abdomen. Preoperatively patient's blood was also collected for serum bilirubin and other liver enzymes estimation. Cases that underwent emergency appendicectomy from January 2004-May 2007 were included in present study.
All the patients presented within 5 hours to 7 days of onset of pain. Out of 110 patients studied, 71(64.54%)were males and 39(35.45%) were females. Age distribution was between 6 years to 73 years with a mean of 29.5 years. Out off 110 cases, 106 cases had AA (positive cases). Among 106 positive cases, TSB was elevated in 87(82.07%) cases.The mean of elevated TSB was 2.26 mg/dL, ranged 1.2-11.5 mg/dL. An interesting finding was observed that patient's in whom the appendix was gangrenous or perforated; elevation of TSB was found to be higher as compared to simple suppurative AA. The specificity, sensitivity was 100%, 82.07%, respectively with predictive value of positive test 100%and predictive value of negative test 17.3%. The liver enzymes were either normal or marginally elevated (<1 time) in most of the cases (Fig.1, 2, 3).
It was found in our study that elevated TSB (without severe abnormalities in the value of liver enzymes)is good indicator of AA. The specificity and sensitivity of elevated TSB was 100% and 82.07% respectively with a predictive value for positive test 100%. If TSB is added to already existing laboratory tests, then the diagnosis of AA in clinically suspected cases can be made with fair degree of accuracy and unnecessary or delay in appendicectomy can be avoided
急性阑尾炎（AA）是外科最常见的腹腔内疾病之一，如果能及时准确诊断，治疗相对容易，否则诊断和治疗延误可导致坏疽穿孔和弥漫性腹膜炎。
本研究旨在确定血清总胆红素（TSB）升高在急性阑尾炎诊断中的作用和预测价值。
所有临床诊断为急性阑尾炎的患者均接受实验室检查和腹部超声检查。术前还采集患者血液进行血清胆红素和其他肝酶检测。本研究纳入了2004年1月至2007年5月期间接受急诊阑尾切除术的病例。
所有患者在疼痛发作后5小时至7天内就诊。在研究的110例患者中，男性71例（64.54%），女性39例（35.45%）。年龄分布在6岁至73岁之间，平均年龄为29.5岁。110例病例中，106例为急性阑尾炎（阳性病例）。在106例阳性病例中，87例（82.07%）TSB升高。TSB升高的平均值为2.26mg/dL，范围为1.2 - 11.5mg/dL。一个有趣的发现是，阑尾坏疽或穿孔的患者，其TSB升高幅度高于单纯化脓性急性阑尾炎患者。特异性、敏感性分别为100%、82.07%，阳性预测值为100%，阴性预测值为17.3%。大多数病例的肝酶正常或轻度升高（<1倍）（图1、2、3）。
我们的研究发现，TSB升高（肝酶值无严重异常）是急性阑尾炎的良好指标。TSB升高的特异性和敏感性分别为100%和82.07%，阳性预测值为100%。如果将TSB添加到现有的实验室检查中，那么临床上疑似急性阑尾炎的病例可以得到较为准确的诊断，避免不必要的阑尾切除术或手术延迟。
