Bilirubin as a Diagnostic Factor in Acute Appendicitis

Acute appendicitis is one of the most common surgical emergencies. The decision for surgical management can be challenging, especially in young patients and in females. There have been many trials to have a scoring system to help the surgical decision with many laboratory and clinical inputs, such as WBC count, C-reactive protein (CRP), and fever.  Objective: In this study, we tried to determine if bilirubin could be used as a diagnostic factor in acute appendicitis to help make the surgical decision.  Methods: A retrospective observational study was conducted, including all the patients who presented to Warwick Hospital's general surgery on-call service between January and May 2024 with a complaint of acute right lower abdominal pain. All the data from patients' records underwent data analysis.  Results: Around 360 patients were identified (n=360), 103 (28.6%) had an appendectomy, 36 (10%) of all the patients had hyperbilirubinemia, and 26 (72.2%) of the patients who had an appendectomy had hyperbilirubinemia. Bilirubin has a specificity of 96.2% and a sensitivity of 27.7% for the diagnosis of acute appendicitis in the acute presentation.  Conclusions: Bilirubin can be used as a highly specific factor for the diagnosis of acute appendicitis in acute right lower abdominal pain to support the surgical decision and to prevent the complications caused by the delay in the surgical management.