Diagnosis and treatment of acute cholecystitis

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  • 急性胆嚢炎の診断と治療

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Abstract

Acute cholecystitis, a common cause of acute abdomen, occurs secondary to gallstones in 90% of cases. The Tokyo Guidelines 2018, which provide diagnostic criteria and severity grading for acute cholangitis and cholecystitis are widely adopted worldwide. Acute cholecystitis is diagnosed based on clinical, laboratory, and imaging findings. Ultrasonography and contrast-enhanced computed tomography are diagnostic modalities recommended for this disease. Laparoscopic cholecystectomy (Lap-C) is considered the gold standard for the treatment of acute cholecystitis. The flowchart for the management of acute cholecystitis is based on severity grading and surgical risk. Early Lap-C is preferred in patients with mild and moderate cholecystitis, who show a low surgical risk. In patients with severe cholecystitis, early Lap-C by a specialist at an advanced center can be performed, if initial treatments achieved a rapid recovery in circulatory dysfunction or renal dysfunction.

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