title: Diagnostic criteria and severity assessment of acute cholecystitis: Tokyo Guidelines.
abstract: The aim of this article is to propose new criteria for the diagnosis and severity assessment of acute cholecystitis, based on a systematic review of the literature and a consensus of experts. A working group reviewed articles with regard to the diagnosis and treatment of acute cholecystitis and extracted the best current available evidence. In addition to the evidence and face-to-face discussions, domestic consensus meetings were held by the experts in order to assess the results. A provisional outcome statement regarding the diagnostic criteria and criteria for severity assessment was discussed and finalized during an International Consensus Meeting held in Tokyo 2006. Patients exhibiting one of the local signs of inflammation, such as Murphy's sign, or a mass, pain or tenderness in the right upper quadrant, as well as one of the systemic signs of inflammation, such as fever, elevated white blood cell count, and elevated C-reactive protein level, are diagnosed as having acute cholecystitis. Patients in whom suspected clinical findings are confirmed by diagnostic imaging are also diagnosed with acute cholecystitis. The severity of acute cholecystitis is classified into three grades, mild (grade I), moderate (grade II), and severe (grade III). Grade I (mild acute cholecystitis) is defined as acute cholecystitis in a patient with no organ dysfunction and limited disease in the gallbladder, making cholecystectomy a low-risk procedure. Grade II (moderate acute cholecystitis) is associated with no organ dysfunction but there is extensive disease in the gallbladder, resulting in difficulty in safely performing a cholecystectomy. Grade II disease is usually characterized by an elevated white blood cell count; a palpable, tender mass in the right upper abdominal quadrant; disease duration of more than 72 h; and imaging studies indicating significant inflammatory changes in the gallbladder. Grade III (severe acute cholecystitis) is defined as acute cholecystitis with organ dysfunction.
authors.affiliation: Department of Gastroenterological Surgery, Kumamoto University Graduate School of Medical Sciences, 1-1-1 Honjo, Kumamoto, 860-8556, Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Hirota
authors.forename: Tadahiro
authors.initials: T
authors.lastname: Takada
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Kawarada
authors.forename: Yuji
authors.initials: Y
authors.lastname: Nimura
authors.forename: Fumihiko
authors.initials: F
authors.lastname: Miura
authors.forename: Koichi
authors.initials: K
authors.lastname: Hirata
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Mayumi
authors.forename: Masahiro
authors.initials: M
authors.lastname: Yoshida
authors.forename: Steven
authors.initials: S
authors.lastname: Strasberg
authors.forename: Henry
authors.initials: H
authors.lastname: Pitt
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Gadacz
authors.forename: Eduardo
authors.initials: E
authors.lastname: de Santibanes
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: Gouma
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Solomkin
authors.forename: Jacques
authors.initials: J
authors.lastname: Belghiti
authors.forename: Horst
authors.initials: H
authors.lastname: Neuhaus
authors.forename: Markus W
authors.initials: MW
authors.lastname: Büchler
authors.forename: Sheung-Tat
authors.initials: ST
authors.lastname: Fan
authors.forename: Chen-Guo
authors.initials: CG
authors.lastname: Ker
authors.forename: Robert T
authors.initials: RT
authors.lastname: Padbury
authors.forename: Kui-Hin
authors.initials: KH
authors.lastname: Liau
authors.forename: Serafin C
authors.initials: SC
authors.lastname: Hilvano
authors.forename: Giulio
authors.initials: G
authors.lastname: Belli
authors.forename: John A
authors.initials: JA
authors.lastname: Windsor
authors.forename: Christos
authors.initials: C
authors.lastname: Dervenis
mesh_terms: D041881:Cholecystitis, Acute / Q000145:classification / Q000175:diagnosis*; D006801:Humans; D008279:Magnetic Resonance Imaging; D012720:Severity of Illness Index; D014041:Tokyo; D014057:Tomography, X-Ray Computed