Abstract
Background
Acute calculous cholecystitis is a condition in which the gallbladder becomes inflamed due to cholelithiasis. Early diagnosis reduces both mortality and morbidity. The aim of this retrospective study was to assess the diagnostic value of the Tokyo guidelines in patients with acute cholecystitis.
Methods
The medical records of patients admitted for acute calculous cholecystitis proven by pathological findings were collected between January 2007 and June 2008. Exclusion criteria included: acalculous cholecystitis, hepatobiliary malignancy, patients younger than 18 years and mortality unrelated to cholecystitis. A total of 235 patients were classified into three groups according to the severity grading in the Tokyo guidelines. Clinical characteristics among these patients were analyzed for comparison.
Results
Among all diagnostic criteria, right upper quarter (RUQ) abdominal pain (97.9%) and thickened gallbladder wall (92.3%) had the highest sensitivity rates, whereas pericholecystic fluid collection (18.3%) and RUQ abdominal mass (0.8%) had the lowest sensitivity rates. Higher sensitivity rates of diagnostic criteria were related to severe cholecystitis, except for Murphy’s sign and white blood cell (WBC) count. The presence of both RUQ abdominal pain and elevated C-reactive protein (55.1%), or both RUQ abdominal pain and elevated WBC count (53.7%), accounted for the highest sensitivity rates in making the definite diagnosis of acute cholecystitis. Seventeen patients (7.2%) without comparable typical image findings were prone to be afebrile and had normal C-reactive protein values compared to those with typical image findings.
Conclusion
Among all diagnostic criteria in the Tokyo guidelines for acute cholecystitis, RUQ abdominal pain and thickened gallbladder wall had the highest sensitivity rates, and RUQ abdominal mass had the lowest sensitivity rate. A combination of diagnostic criteria with different pathophysiologic findings, as noted in the Tokyo guidelines, can help clinicians make the correct diagnosis for patients with acute calculous cholecystitis.
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References
Strasberg SM. Acute calculous cholecystitis. N Engl J Med. 2008;358:2804–11.
Yeatman TJ. Emphysematous cholecystitis: an insidious variant of acute cholecystitis. Am J Emerg Med. 1986;4:163–6.
Roslyn JJ, DenBesten L, Thompson JE Jr, Silverman BF. Roles of lithogenic bile and cystic duct occlusion in the pathogenesis of acute cholecystitis. Am J Surg. 1980;140:126–30.
Claesson B, Holmlund D, Mätzsch T. Biliary microflora in acute cholecystitis and the clinical implications. Acta Chir Scand. 1984;150:229–37.
Takada T, Kawarada Y, Nimura Y, Yoshida M, Mayumi T, Sekimoto M, et al. Background: Tokyo guidelines for the management of acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Surg. 2007;14:1–10.
Hirota M, Takada T, Kawarada Y, Nimura Y, Miura F, Hirata K, et al. Diagnostic criteria and severity assessment of acute cholecystitis: Tokyo guidelines. J Hepatobiliary Pancreat Surg. 2007;14:78–82.
Yamashita Y, Takada T, Kawarada Y, Nimura Y, Hirota M, Miura F, et al. Surgical treatment of patients with acute cholecystitis: Tokyo guidelines. J Hepatobiliary Pancreat Surg. 2007;14:91–7.
Lee SW, Yang SS, Chang CS, Yeh HJ. Impact of the Tokyo guidelines on the management of patients with acute calculous cholecystitis. J Gastroenterol Hepatol. 2009;24(12):1857–61.
Adedeji OA, McAdam WA. Murphy’s sign, acute cholecystitis and elderly people. J R Coll Surg Edinb. 1996;41:88–9.
Morrow DJ, Thompson J, Wilson SE. Acute cholecystitis in the elderly: a surgical emergency. Arch Surg. 1978;113:1149–52.
Ralls PW, Colletti PM, Lapin SA, Chandrasoma P, Boswell WD Jr, Ngo C, et al. Real-time sonography in suspected acute cholecystitis: prospective evaluation of primary and secondary signs. Radiology. 1985;155:767–71.
Bree RL. Further observations on the usefulness of the sonographic Murphy sign in the evaluation of suspected acute cholecystitis. J Clin Ultrasound. 1995;23:169–72.
Carl AW, Thiru VL, Richard WS. Current diagnosis and treatment of cholecystitis. Curr Surg. 2002;59(1):51–4.
Robert LT, Nicole KR, Kaveh GS. Dose this patient have acute cholecystitis? JAMA. 2003;289(1):80–6.
Dunlop MG, King PM, Gunn AA. Acute abdominal pain. J R Coll Surg Edinb. 1989;34:124–7.
Gruber PJ, Silverman RA, Gottesfeld S, Flaster E. Presence of fever and leukocytosis in acute cholecystitis. Ann Emerg Med. 1996;28:273–7.
Juvonen T, Kiviniemi H, Niemela O, Kairaluoma MI. Diagnostic accuracy of ultrasonography and C reactive protein concentration in acute cholecystitis: a prospective clinical study. Eur J Surg. 1992;158(6):365–9.
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Lee, SW., Chang, CS., Lee, TY. et al. The role of the Tokyo guidelines in the diagnosis of acute calculous cholecystitis. J Hepatobiliary Pancreat Sci 17, 879–884 (2010). https://doi.org/10.1007/s00534-010-0289-x
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DOI: https://doi.org/10.1007/s00534-010-0289-x