🟠 Acute Cholecystitis Severity & Management (TG18)
This tool grades acute cholecystitis by Tokyo Guidelines TG18 and surgical risk and gives direction for cholecystectomy, percutaneous cholecystostomy, and antibiotics.
Clinical takeaway
Early cholecystectomy outperforms delayed surgery in low-risk patients, while percutaneous cholecystostomy is a bridge — not a cure — for those who cannot tolerate surgery. (original synthesis · not guideline verbatim)
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When to use
Use to assign TG18 severity and choose between early laparoscopic cholecystectomy and percutaneous drainage based on grade and operative risk.
How it works
Grade III = organ dysfunction; Grade II = any of WBC > 18,000/tender RUQ mass/symptoms > 72 h/marked local inflammation; otherwise Grade I. Low risk (CCI ≤ 5, ASA-PS ≤ 2) → early LC; high risk/severe → cholecystostomy first.
Key points
- Early cholecystectomy outperforms delayed surgery in low-risk patients, while percutaneous cholecystostomy is a bridge — not a cure — for those who cannot tolerate surgery. (original synthesis · not guideline verbatim)
- Antibiotic courses can shorten to within ~4 days after source control.
- Grade III demands organ support and usually drainage, with surgery only under strict conditions.
References
Decision support for licensed clinicians only; not a substitute for clinical judgement, diagnosis or local protocols.
Worked calculation
The values below come from this tool's own example placeholders and are computed server-side with the formula shown on this page, so the arithmetic can be checked quickly. It demonstrates how to substitute values only — it is not clinical advice and not a real case.
| Any organ dysfunction (cardiovascular/neurologic/respiratory/renal/hepatic/hematologic) | Present |
|---|---|
| Any moderate criterion (WBC > 18,000 / palpable tender RUQ mass / symptoms > 72 h / marked local inflammation) | Present |
| Surgical/anesthetic risk (CCI, ASA-PS) | Low (CCI ≤ 5, ASA-PS ≤ 2) |
→SeverityGrade III (severe)
- Management：Organ support + antibiotics; early/urgent percutaneous cholecystostomy (PTGBD) drainage; early laparoscopic cholecystectomy only under strict conditions (reversible organ failure, no negative predictors, CCI ≤ 3, ASA-PS ≤ 2, advanced center); elective surgery after stabilization
- Antibiotics：Empiric broad-spectrum antibiotics covering Gram-negative Enterobacteriaceae and anaerobes; obtain bile/blood cultures; course can often be shortened (within ~4 days) after source control (resection/drainage)
- Cannot tolerate surgery：High surgical risk, shock, or surgery refused: percutaneous cholecystostomy (PTGBD) to control infection as a bridge to surgery (conservative, non-curative, prone to recurrence)
| Any organ dysfunction (cardiovascular/neurologic/respiratory/renal/hepatic/hematologic) | Absent |
|---|---|
| Any moderate criterion (WBC > 18,000 / palpable tender RUQ mass / symptoms > 72 h / marked local inflammation) | Absent |
| Surgical/anesthetic risk (CCI, ASA-PS) | High |
→SeverityGrade I (mild)
- Management：Antibiotics + support; for high surgical risk, conservative/percutaneous cholecystostomy then elective surgery
- Antibiotics：Empiric broad-spectrum antibiotics covering Gram-negative Enterobacteriaceae and anaerobes; obtain bile/blood cultures; course can often be shortened (within ~4 days) after source control (resection/drainage)
- Cannot tolerate surgery：High surgical risk, shock, or surgery refused: percutaneous cholecystostomy (PTGBD) to control infection as a bridge to surgery (conservative, non-curative, prone to recurrence)
Frequently asked questions
- What is Acute Cholecystitis Severity & Management (TG18)?
- This tool grades acute cholecystitis by Tokyo Guidelines TG18 and surgical risk and gives direction for cholecystectomy, percutaneous cholecystostomy, and antibiotics.
- How is Acute Cholecystitis Severity & Management (TG18) calculated? What is the core formula?
- Grade III = organ dysfunction; Grade II = any of WBC > 18,000/tender RUQ mass/symptoms > 72 h/marked local inflammation; otherwise Grade I. Low risk (CCI ≤ 5, ASA-PS ≤ 2) → early LC; high risk/severe → cholecystostomy first.
- When is Acute Cholecystitis Severity & Management (TG18) used?
- Use to assign TG18 severity and choose between early laparoscopic cholecystectomy and percutaneous drainage based on grade and operative risk.
- What are the key clinical points for Acute Cholecystitis Severity & Management (TG18)?
- Early cholecystectomy outperforms delayed surgery in low-risk patients, while percutaneous cholecystostomy is a bridge — not a cure — for those who cannot tolerate surgery. (original synthesis · not guideline verbatim) Antibiotic courses can shorten to within ~4 days after source control. Grade III demands organ support and usually drainage, with surgery only under strict conditions.
- What are the limits and cautions when using Acute Cholecystitis Severity & Management (TG18)?
- For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.
- How is Acute Cholecystitis Severity & Management (TG18) calculated in practice? Can you show a worked example?
- Inputs: Any organ dysfunction (cardiovascular/neurologic/respiratory/renal/hepatic/hematologic) Present, Any moderate criterion (WBC > 18,000 / palpable tender RUQ mass / symptoms > 72 h / marked local inflammation) Present, Surgical/anesthetic risk (CCI, ASA-PS) Low (CCI ≤ 5, ASA-PS ≤ 2) → Result: Severity Grade III (severe)（Management: Organ support + antibiotics; early/urgent percutaneous cholecystostomy (PTGBD) drainage; early laparoscopic cholecystectomy only under strict conditions (reversible organ failure, no negative predictors, CCI ≤ 3, ASA-PS ≤ 2, advanced center); elective surgery after stabilization, Antibiotics: Empiric broad-spectrum antibiotics covering Gram-negative Enterobacteriaceae and anaerobes; obtain bile/blood cultures; course can often be shortened (within ~4 days) after source control (resection/drainage), Cannot tolerate surgery: High surgical risk, shock, or surgery refused: percutaneous cholecystostomy (PTGBD) to control infection as a bridge to surgery (conservative, non-curative, prone to recurrence)） Inputs: Any organ dysfunction (cardiovascular/neurologic/respiratory/renal/hepatic/hematologic) Absent, Any moderate criterion (WBC > 18,000 / palpable tender RUQ mass / symptoms > 72 h / marked local inflammation) Absent, Surgical/anesthetic risk (CCI, ASA-PS) High → Result: Severity Grade I (mild)（Management: Antibiotics + support; for high surgical risk, conservative/percutaneous cholecystostomy then elective surgery, Antibiotics: Empiric broad-spectrum antibiotics covering Gram-negative Enterobacteriaceae and anaerobes; obtain bile/blood cultures; course can often be shortened (within ~4 days) after source control (resection/drainage), Cannot tolerate surgery: High surgical risk, shock, or surgery refused: percutaneous cholecystostomy (PTGBD) to control infection as a bridge to surgery (conservative, non-curative, prone to recurrence)）