Background: Approximately 6% of the population suffers from acute appendicitis during their lifetime; therefore, much effort has been directed toward early diagnosis and intervention. Hence, the present study was conducted to establish Hyperbilirubinemia as a predictor of gangrenous/perforated appendicitis. Material & Methods: The present cohort, prospective study was conducted among 30 cases of acute appendicitis over a period of two years. Patients of age between 15 to 65 were included in the study. Patients were clinically evaluated, routine examination was performed and the investigations were done. These cases were operated and clinical diagnosis was confirmed per-operatively and post-operatively by histopathological examination. Their clinical and investigative data were compiled and analyzed. Results: In the present study, 83.33% cases were male and 16.66% were female. Maximum cases belong to age group 15-25 years. Among 30 cases clinically diagnosed as acute appendicitis preoperatively, 24 had acute appendicitis, 2 had gangrenous appendix, 4 cases had perforated appendix and no patient had normal appendix. According to histopathology, 80% cases were negative in which acute appendicitis with no perforation or gangrene was present and in 20% cases were positive in which acute appendicitis with perforation or gangrene was present. Conclusion: The study concluded that total serum bilirubin was found to be significantly increased in case of gangrenous/perforated appendicitis. Keywords: Gangrenous/perforated appendicitis, total serum bilirubin, histopathological examination.