Highlights
- •Patients with acute cholecystitis or biliary colic often have elevated bilirubin.
- •Trending elevated bilirubin does not help predict common bile duct stones (CBDS).
- •Patients with elevated bilirubin should undergo immediate imaging or surgery.
- •White blood cell count trending opposite bilirubin may be predict CBDS.
Abstract
Background
We hypothesized that trends in total bilirubin in the context of cholecystitis and
symptomatic cholelithiasis could be used to guide testing for the presence of common
bile duct stones (CBDS).
Methods
A review of adult patients with acute cholecystitis or biliary colic with elevated
total bilirubin and at least two levels drawn prior to procedural intervention was
performed. Trends of total bilirubin and other serum makers were examined to predict
the presence of CBDS.
Results
The total bilirubin level at presentation, average over 24 h and average over 48 h
(3.74 mg/dl vs. 2.29 mg/dl, p = 0.005; 3.72 mg/dl vs. 2.40 mg/dl, p = 0.009; 2.41 mg/dl
vs. 1.47 mg/dl, p < 0.001) respectively, were all higher in those with CBDS. However,
prediction was not improved by following levels over time.
Conclusion
Patients presenting with elevated serum bilirubin, should undergo immediate imaging
or procedural intervention rather than obtaining follow-up bilirubin levels.
Keywords
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Article info
Publication history
Published online: June 18, 2018
Accepted:
June 14,
2018
Received in revised form:
June 6,
2018
Received:
April 4,
2018
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
