Cirujano General

Contents by Year, Volume and Issue

Table of Contents

General Information

Instructions for Authors

Message to Editor

Editorial Board

>Journals >Cirujano General >Year 2017, Issue 4

Palma-Ramírez EJ, Rendón-Macías ME
Usefulness of bilirubin serum levels in the diagnosis of acute appendicitis
Cir Gen 2017; 39 (4)

Language: Español
References: 21
Page: 226-231
PDF: 4. Kb.

Full text


Introduction: Even with the availability of scales (Alvarado) to improve diagnostic accuracy in acute appendicitis, incidental performing surgeries and delayed diagnosis and treatment persist. Objective: To determine the usefulness of measuring serum bilirubin to improve the diagnosis of acute appendicitis. Material and method: Patients older than 18 years, diagnosed with suspected acute appendicitis (Alvarado 5-8) satisfying the inclusion criteria. Their levels of total serum bilirubin (TB), indirect (IB) and direct (DB) bilirubins were determined before surgery. The definitive diagnosis was histopathological, or depended on the clinical course in nonsurgical patients. ROC (receptor operating curve) curves were used to evaluate the performance and the best cut point in each test, and to determine the sensitivity and specificity. Results: Eighty-six patients were included, 52 (60%) with a confirmed diagnosis of acute appendicitis. Sixty-five (75%) required surgical management (56 laparoscopic surgery, nine laparotomy); in 13 (38%), surgery was incidental. The best cut level for TB ( ≥ 1 mg/dl) had a sensitivity of 79.4% and a specificity of 67.2%; for IB ( ≥ 0.6 mg/dl), a sensitivity of 65.5% and specificity of 73.6%; and DB ( ≥ 0.2 mg/dl), a sensitivity of 70.6% and specificity of 76.9%. Levels of diagnostic confirmation: TB ≥ 1.8 mg/dL, IB ≥ 1.5 mg/dl and DB ≥ 0.5 mg/dl. Conclusion: Serum bilirubin levels can be diagnostically useful, especially in high numbers.

Key words: Bilirubins, appendicitis, diagnosis.


  1. Korner H, Söndenaa K, Söreide JA, Andersen E, Nysted A, Lende TH, et al. Incidence of acute non perforated and perforated appendicitis: age-specific and sex specific analysis. World J Surg. 1997; 21: 313-317.

  2. Flum DR, Morris A, Koepsell T, Dellinger EP. Has misdiagnosis of appendicitis decreased over time? A population-based analysis. JAMA. 2001; 286: 1748-1753.

  3. Schwarz A, Bolke E, Peiper M, Schulte am Esch J, Steinbach G, van Griensven M, et al. Inflammatory peritoneal reaction after perforated appendicitis: continuous peritoneal lavage versus non lavage. Eur J Med Res. 2007; 12: 200-205.

  4. Mueller BA, Daling JR, Moore DE, Weiss NS, Spadoni LR, Stadel BV, et al. Appendectomy and the risk of tubal infertility. N Engl J Med. 1986; 315: 1506-1508.

  5. Addis DG, Shaffer N, Fowler BS, Tauxe RV. The epidemiology of appendicitis and appendicectomy in the United States. Am J Epidemiol. 1990; 132: 910-925.

  6. Wesson DE, Singer JI, Wiley FJ. Acute appendicitis in children: clinical manifestations and diagnosis. UpToDate. (Consultado el 4 de diciembre de 2014.

  7. Escribá A, Gamell AM, Fernández Y, Quintillá JM, Cubells CL. Prospective validation of two systems of classification for the diagnosis of acute appendicitis. Pediatr Emerg Care. 2011; 27: 165-169.

  8. Kaiser S, Frenckner B, Jorulf HK. Suspected appendicitis in children: US an CT —A prospective randomized study. Radiology. 2002; 223: 633-638.

  9. Douglas CD, Macpherson NE, Davison PM, Gani JS. Randomised controlled trial of ultrasonography in diagnosis of acute appendicitis, incorporating the Alvarado score. BMJ. 2000; 321: 919-922.

  10. Funaki B, Grosskreutz SR, Funaki CN. Using unenhanced helical CT with enteric contrast material for suspected appendicitis in patients treated at a community hospital. AJR Am J Roentgenol. 1998; 171: 997-1001.

  11. Stroman DL, Bayouth CV, Kuhn JA, Westmoreland M, Jones RC, Fisher TL, et al. The role of computed tomography in the diagnosis of acute appendicitis. Am J Surg. 1999; 178: 485-489.

  12. Flum DR, Koepsell T. The clinical and economic correlates of misdiagnosed appendicitis: Nationwide analysis. Arch Surg. 2002; 137: 799-804.

  13. Noh H, Chang SJ, Han A. The diagnostic values of preoperative laboratory markers in children with complicated appendicitis. J Korean Surg Soc. 2012; 83: 237-241.

  14. Kaya B, Sana B, Eris C, Karabulut K, Bat O, Kutanis R. The diagnostic value of D-dimer, procalcitonin and CPR in acute appendicitis. Int J Med Sci. 2012; 9: 909-915.

  15. Whitehead MW, Hainsworth I, Kingham JG. The causes of obvious jaundice in South West Wales: perceptions versus reality. Gut. 2001; 48: 409-413.

  16. Chand N, Sanyal AJ. Sepsis-induced cholestasis. Hepatology. 2007; 45: 230-241.

  17. Shander A. Anemia in the critically ill. Crit Care Clin. 2004; 20: 159-178.

  18. Roelofsen H, van der Veere CN, Ottenhoff R, Schoemaker B, Jansen PL, Oude Elferink RP. Decreased bilirubin transport in the perfused liver of endotoxemic rats. Gastroenterology. 1994; 107: 1075-1084.

  19. Bolder U, Ton-Nu HT, Schteingart CD, Frick E, Hofmann AF. Hepatocyte transport of bile acids and organic anions in endotoxemic rats: impaired uptake and secretion. Gastroenterology. 1997; 112: 214-225.

  20. Green RM, Beier D, Gollan JL. Regulation of hepatocyte bile salt transporters by endotoxin and inflammatory cytokines in rodents. Gastroenterology. 1996; 111: 193-198.

  21. Whiting JF, Green RM, Rosenbluth AB, Gollan JL. Tumor necrosis factor-alpha decreases hepatocyte bile salt uptake and mediates endotoxin-induced cholestasis. Hepatology. 1995; 22: 1273-1278.

>Journals >Cirujano General >Year 2017, Issue 4

· Journal Index 
· Links 

Copyright 2019