ToolsCalculators
Tokyo Guidelines for Acute Cholecystitis 2018 (TG18)
Diagnostic criteria and severity grading for acute cholecystitis.
Tokyo Guidelines for Acute Cholecystitis 2018 (TG18)
A. Local signs of inflammation (Murphy's sign, or RUQ mass / pain / tenderness)
B. Systemic signs of inflammation (fever, elevated CRP, or elevated WBC)
C. Imaging findings characteristic of acute cholecystitis
Grade III: organ dysfunction (vasopressor-requiring hypotension, altered consciousness, PaO2/FiO2 <300, creatinine >2 mg/dL, INR >1.5, or platelets <100k)
WBC >18,000 /uL
Palpable tender mass in the right upper quadrant
Duration of complaints >72 hours
Marked local inflammation (gangrenous or emphysematous cholecystitis, pericholecystic/hepatic abscess, biliary peritonitis)
ResultDiagnostic criteria not met
Requires one item from A plus one from B to be suspected.
- Diagnosis
- Diagnostic criteria not met
When to use
- Confirming a diagnosis of acute cholecystitis and grading severity to guide the timing and type of intervention.
Formula
Suspected: one A item (local inflammation) plus one B item (systemic inflammation). Definite: A and B plus C (imaging). Grade III = any organ dysfunction; Grade II = any of (WBC >18k, palpable tender RUQ mass, symptoms >72 h, marked local inflammation); Grade I = neither.
Pearls and pitfalls
- Early laparoscopic cholecystectomy is favoured for Grade I and selected Grade II disease.
- Grade III requires organ support and often initial gallbladder drainage.