Effectiveness of Tokyo Guidelines in Diagnosis and Assessment of Severity of Acute Cholecystitis

Background: Acute cholecystitis (AC) is an acute inflammation of the gallbladder wall. During the course of AC, concurrent complications such as acute cholangitis and biliary pancreatitis, may occur. So, further diagnostic workup and suitable therapeutic methods are required. Objective: This prospective study aimed to determine the validity of the new "Tokyo 2018 (TG18)" guidelines for diagnosing and assessing the severity of AC, as well as to define the outcome.
Subjects and methods: One hundred individuals with symptoms of AC participated in this study. Every participant underwent a general examination and history taking. Also, abdominal examination was done to assess the presence of right upper quadrant (RUQ) mass/pain/tenderness and Murphy’s sign, followed by radiographic and lab tests. The AC severity assessment criteria and TG18 diagnosis were used.
Results: The percentages of patients with tachycardia, tachypnea, Murphy sign and RUQ mass were considerably higher in  the grades II + III group in comparison with the grade I group (0.005, 0.005, <0.001 and <0.001 respectively). In addition, the averages of systolic and diastolic blood pressures in the grades II + III group were significantly less than in grade I (p < 0.001 for both). The mean temperature was significantly elevated in the grades II + III group than in the grade I (p < 0.001 for both). The comparison between the AC grading groups regarding the intervention and outcome and no significant difference was recorded.
Conclusion: There were no clear-cut standards for diagnosing AC, with the exception of a few well-known clinical symptoms, such as Murphy's sign. The TG18 guidelines are therefore helpful for therapy, severity rating and early diagnosis all of which reduce patient morbidity and mortality.