Saxena Divish, Tandon Mrinal, Shah Yunus, Gedam B S
Department of Surgery, NKP Salve Institute of Medical Sciences, Digdoh Hills, Nagpur, Maharashtra, India.
Euroasian J Hepatogastroenterol. 2015 Jul-Dec;5(2):87-89. doi: 10.5005/jp-journals-10018-1141. Epub 2016 Jul 9.
The certainty of diagnosing acute appendicitis in patients presenting with right iliac fossa pain still remains a mystery though acute appendicitis being the commonest surgical procedure done in emergency. In acute appendicitis, serum bilirubin levels are raised due to hepatocellular damage as a result of direct insult caused by Gram-negative bacterial endotoxemia. The need for the study is to conclude whether the serum bilirubin can be considered as a new laboratory marker to aid in the diagnosis of acute appendicitis and if so, does it have the predictive capacity to warn us about appendicular perforation.
This is a prospective study carried out at rural tertiary healthcare center and includes 213 patients clinically diagnosed as acute appendicitis.
Out of 213 patients, raised serum bilirubin ≥1.2 mg/dl was present in 195 (91.5%) patients, out of which 194 (99.4%) patients had histopathologically inflamed appendix and this difference was statistically highly significant with p-value < 0.0001. In this study, 32 patients had perforated appendix. Out of those, 30 patients had bilirubin ≥ 4 mg/dl and 2 patients had bilirubin level between 1.2 and < 4 mg/dl. Raised serum bilirubin (≥4 mg/dl) was present in 35 (17.9%) patients, out of which 30 (87.7%) patients had perforated appendix.
Saxena D, Tandon M, Shah Y, Gedam BS. Hyperbilirubinemia as a Diagnostic Tool for the Prediction of Appendicular Perforation: A Prospective Study. Euroasian J Hepato-Gastroenterol 2015;5(2):87-89.
尽管急性阑尾炎是急诊中最常见的外科手术，但对于表现为右下腹疼痛的患者，诊断急性阑尾炎的准确性仍然是个谜。在急性阑尾炎中，由于革兰氏阴性菌内毒素血症造成的直接损伤导致肝细胞受损，血清胆红素水平会升高。本研究的目的是确定血清胆红素是否可被视为有助于诊断急性阑尾炎的新实验室指标，如果是，它是否具有预测阑尾穿孔的能力。
这是一项在农村三级医疗保健中心进行的前瞻性研究，纳入了213例临床诊断为急性阑尾炎的患者。
213例患者中，195例（91.5%）血清胆红素升高≥1.2mg/dl，其中194例（99.4%）患者的阑尾组织病理学检查显示有炎症，这种差异具有高度统计学意义，p值<0.0001。本研究中，32例患者阑尾穿孔。其中，30例患者胆红素≥4mg/dl，2例患者胆红素水平在1.2至<4mg/dl之间。35例（17.9%）患者血清胆红素升高（≥4mg/dl），其中30例（87.7%）患者阑尾穿孔。
Saxena D, Tandon M, Shah Y, Gedam BS. 高胆红素血症作为预测阑尾穿孔的诊断工具：一项前瞻性研究。《欧亚肝脏胃肠病学杂志》2015；5(2):87 - 89。
