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.

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