🟠 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.
Acute Cholecystitis Severity & Management (TG18)
Any organ dysfunction (cardiovascular/neurologic/respiratory/renal/hepatic/hematologic)
Any moderate criterion (WBC > 18,000 / palpable tender RUQ mass / symptoms > 72 h / marked local inflammation)
Surgical/anesthetic risk (CCI, ASA-PS)
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.