Original single-incision laparoscopic cholecystectomy for acute inflammation of the gallbladder

Table 2 Tokyo guideline diagnosis criteria and severity assessment of acute cholangitis

Diagnosis criteria (suspected diagnosis and definite diagnosis)

Severity assessment

A: Clinical context and clinical manifestations

History of biliary disease

Fever and/or chills

Jaundice

Abdominal pain (right upper quadrant or upper abdominal)

B: Laboratory data

Evidence of inflammatory response1

Abnormal liver function tests2

C: Imaging findings

Biliary dilation, or evidence of etiology (stricture, stone, stent, etc.)

Two or more items in A

Charcot’s triad (2 + 3 + 4)

Two or more items in A + both items in B + C

Severity assessment

Mild (grade I)

Acute cholangitis that responds to initial medical treatment3

Moderate (grade II)

Acute cholangitis that does not respond to initial medical treatmentc and is not accompanied by organ dysfunction

Severe (grade III)

Acute cholangitis that is associated with the onset of dysfunction at least in any one of the following organs/systems

Cardiovascular system; hypotension requiring dopamine ≥ 5 μg/kg per minute, or any dose of dobutamine

Nervous system: disturbance of consciousness

Respiratory system: PaO2/FiO2 ratio < 300

Kidney: serum creatinine > 2.0 mg/dL

Liver: PT-INR > 1.5

Hematological system: platelet count < 100 000/μL

Compromised patients, for example, elderly (> 75 years old) and patients with comorbidity, should be monitored closely.

¹Abnormal white blood cell count, increased serum C-reactive protein level, and other changes including inflammation;

²increased serum alkaline phosphatase, γ-glutamyltransferase, aspartate aminotransferase and alanine aminotransferase levels;

³general supportive care and antibiotics. PT-INR: Prothrombin time and international normalized ratio.