Predictive value of total leucocyte count (TLC), bilirubin and C-reactive protein in the diagnosis of gangrenous and perforated appendicitis.

Abstract

Acute appendicitis is the most common cause of acute abdomen. Most of the cases are diagnosed on history, clinical examination and raised TLC but gangrenous and perforated appendicitis are difficult to diagnose. The TLC, Serum bilirubin and C‑reactive protein (CRP) have been shown to indicate perforation in appendicitis. Objectives: The purpose of this study was to evaluate the role of TLC, hyperbilirubinemia and CRP in the diagnosis of perforated appendix and surgery should be planned. Study Design: Prospective study. Setting: Department of Surgery in Sheikh Zayed Medical College Rahim Yar Khan. Period: 12 months from November 2017 to October 2018. Material & Methods: This study consisted of patients admitted with the clinical suspicion of acute appendicitis. ALVARADO score was calculated. 120 patients with ALVARADO score more than 6 and histologically diagnosed appendicitis were finally included in the study. A proforma was filled which included patients name, age, sex, duration of pain, TLC count, C-Reactive protein (CRP) level and serum total bilirubin level and diagnosis of appendicitis (acute appendicitis, gangrenous appendicitis and perforated appendicitis. Patients were divided into 3 groups. Group A comprised of patients with features of simple appendicitis (AA), Group B Gangrenous appendicitis (GA) and group C Perforated appendicitis (PA). Results: There were 81 patients of acute appendicitis, 13 patients of gangrenous appendicitis and 26 patients of perforated appendicitis. TLC was raised in 13 patients of AA, 10 patients of gangrenous appendicitis and 24 patients of perforated appendicitis. Hyperbillirubinemia (>1mg/dl) was present in 9 patients of GA and 20 patients of PA. Raised C-Reactive protein level (>5mg) was present in 10 patients of GA and 21 patients of PA. There was significant correlation of raised TLC, hyperbillirubinemia and C-reactive protein in gangrenous and perforated appendicitis and p value was less than 0.05. Predictive value of bilirubin in GA and PA was 56.25 % and 74.04 %respectively. Predictive value of C Reactive Protein in GA and PA was 41.66 and 60 respectively. Predictive value of TLC in GA and PA was 43.47 and 60.86 respectively. Conclusion: All the patients who present with pain in right iliac fossa, lower abdominal tenderness and rigidity, Alvarado score>7, raised TLC, CRP and hybillirubinemia are the suspected case of perforated appendix and should be aggressively resuscitated and operated.