Assessing severity grading of acute cholecystitis according to Tokyo guidelines 2013 and outcome of conservative management

Abstract

BACKGROUND: Acute cholecystitis is acute inflammation of the gall bladder. About 90% of cases result from obstruction of the cystic duct by gallstones or by biliary sludge that has become impacted at the neck of the gallbladder. If the inflammation persists it may cause perforation or gangrene of the gallbladder

OBJECTIVES:  To stratify the patients with AC into various severity grading using clinical ,biochemical and radiological investigations according to TOKYO guidelines 2013 ;To assess the feasibility of conservative management for different grades of severity  ; identify patients who failed conservative management

PARTICIPANTS: 112 patients diagnosed as acute cholecystitis were selected as per the inclusion criteria

STUDY DESIGN: Prospective observational study

METHODS: The clinical profile of patients and severity of cholecystitis according to TG13 was noted .All the patients were managed with antibiotics and supportive care. Patients were closely monitored for any change in severity .Any percutaneous intervention if required was noted . The need for surgery was taken as a failure of conservative management.

RESULTS: Out of 112 patients ,the maximum number of patients(31.3%)  were in the age group of 45 to 59 years. A male to female ratio was 1: 3.5. Obesity and Diabetes mellitus were the most common associated comorbidity.LFT was normal in majority (78.6%) of patients.57.1% had mild ,38.4% had moderate and 4.5% had severe grading according to Tokyo guidelines.97.3% of the cases were managed conservatively, only 2.7% required open surgical intervention.

CONCLUSION: Conservative management has been the gold standard treatment for AC in our settings. In particular  percutaneous  cholecystostomy has been considered as the first line treatment option for antibiotic-refractory cases

IMPLICATION: TG 13 severity grading helps in assessing the clinical outcome of patients