Background: Given the foregoing, the aims of the present study were to (1) establish whether hyperbilirubinemia is associated with acute appendicitis; (2) evaluate its validity as a diagnostic marker for acute appendicitis; and (3) establish whether elevated bilirubin levels might predict appendicular perforation. The goal of this study is to determine whether or not preoperative serum bilirubin levels are useful for diagnosing appendicular perforation. The goals of this study were to (1) determine whether serum bilirubin is associated with acute appendicitis, and (2) evaluate its usefulness as a diagnostic marker for this illness. For the purpose of determining whether or not elevated serum bilirubin levels can be used as a predictor of appendicular perforation