Aim: To find the association of hyperbilirubinemia in perforated and gangrenous appendix Methods: In this prospective study, 50 patients with acute appendicitis were included. Patients were evaluated by detailed history, routine examination on initial contact with patients. Bilirubin and other blood parameters were evaluated. Results: In 50 patients, 30 were male and 20 were female patients. 23 patients (46%) were had Acute appendicitis and 27 patients (54%) had Perforated /gangrenous appendicitis. Bilirubin level in acute appendicitis was 1.0mg/dl and in perforated/gangrenous appendicitis was 1.4mg/dl. Conclusion: Hyperbilirubinemia was significantly higher in gangrenous and perforated appendicitis than those patients with acute appendicitis. Serum Bilirubin is an important adjunct in diagnosing the presence of gangrenous and perforated appendicitis.