Management of Acute Cholecystitis

Seung-Ok Lee; Sung Kyun Yim

doi:10.4166/kjg.2018.71.5.264

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Lee and Yim: Management of Acute Cholecystitis

Review Article

Korean J Gastroenterol 2018;71(5):264-268.

Published online: 4 October 2018

DOI: https://doi.org/10.4166/kjg.2018.71.5.264

Management of Acute Cholecystitis

Seung-Ok Lee, Sung Kyun Yim

Department of Internal Medicine, Biomedical Research Institute, Chonbuk National University Hospital, Chonbuk National University Medical School, Jeonju, Korea

Correspondence to: Seung-Ok Lee, Department of Internal Medicine, Chonbuk National University Hospital, Chonbuk National University Medical School, 20 Geonji-ro Deokjin-gu, Jeonju 54907, Korea. Tel: +82-63-250-1289, Fax: +82-63-254-1609, E-mail: solee@jbnu.ac.kr

Received 20 April 2018 Revised 1 May 2018 Accepted 1 May 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Acute cholecystitis is a common serious complication of gallstones. The reported mortality of acute cholecystitis is approximately 3%, but the rate increases with age or comorbidity of the patient. If appropriate treatment is delayed, complications can develop as a consequence with a grave prognosis. The current standard of care in acute cholecystitis is an early laparoscopic cholecystectomy with the appropriate administration of fluid, electrolyte, and antibiotics. On the other hand, the severity of the disease and patient's operational risk must be considered. In those with high operational risks, gall bladder drainage can be performed as an alternative. Currently percutaneous and endoscopic drainage are available and show clinical success in most cases. After recovering from acute cholecystitis, the patients who have undergone drainage should be considered for cholecystectomy as a definitive treatment. However, in elderly patients or patients with significant comorbidity, operational risks may still be high, making cholecystectomy inappropriate. In these patients, gallstone removal using the percutaneous tract or endoscopy may be considered.

Keywords: Cholecystitis, acute, Drainage, Cholecystectomy

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Table 1.

Severity Grading of Acute Cholecystitis

Grade III (severe)	Any of the following:
	1. Cardiovascular dysfunction: hypotension requiring treatment with dopamine ≥5 μ g/kg per min, or any dose of norepinephrine
	2. Neurological dysfunction: decreased level of consciousness
	3. Respiratory dysfunction: PaO₂/FiO₂ ratio <300
	4. Renal dysfunction: oliguria, creatinine >2.0 mg/dL
	5. Hepatic dysfunction: PT‐ INR >1.5
	6. Hematological dysfunction: platelet count <100,000/mm³
Grade II (moderate)	Any of the following:
	1. Elevated WBC count (>18,000/mm³)
	2. Palpable tender mass in the right upper abdominal quadrant
	3. Duration of complaints >72 hours
	4. Marked local inflammation (gangrenous cholecystitis, pericholecystic abscess, hepatic abscess, biliary peritonitis, emphysematous cholecystitis)
Grade I (mild)	Those do not meet the criteria of “Grade III” or “Grade II” acute cholecystitis.
	Acute cholecystitis in a healthy patient with no organ dysfunction and mild inflammatory changes in the gallbladder, making cholecystectomy a safe and low‐ risk operative procedure.

PT-INR, prothrombin time-international normalized ratio; WBC, white blood cell.

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