The aim of this article is to propose new criteria for the diagnosis and severity assessment of
acute cholecystitis, based on a systematic review of the literature and a consensus of experts. A working group reviewed articles with regard to the diagnosis and treatment of
acute cholecystitis and extracted the best current available evidence. In addition to the evidence and face-to-face discussions, domestic consensus meetings were held by the experts in order to assess the results. A provisional outcome statement regarding the diagnostic criteria and criteria for severity assessment was discussed and finalized during an International Consensus Meeting held in Tokyo 2006. Patients exhibiting one of the local signs of
inflammation, such as Murphy's sign, or a mass,
pain or tenderness in the right upper quadrant, as well as one of the systemic signs of
inflammation, such as
fever, elevated white blood cell count, and elevated
C-reactive protein level, are diagnosed as having
acute cholecystitis. Patients in whom suspected clinical findings are confirmed by diagnostic imaging are also diagnosed with
acute cholecystitis. The severity of
acute cholecystitis is classified into three grades, mild (grade I), moderate (grade II), and severe (grade III). Grade I (mild
acute cholecystitis) is defined as
acute cholecystitis in a patient with no organ dysfunction and limited disease in the gallbladder, making
cholecystectomy a low-risk procedure. Grade II (moderate
acute cholecystitis) is associated with no organ dysfunction but there is extensive disease in the gallbladder, resulting in difficulty in safely performing a
cholecystectomy. Grade II disease is usually characterized by an elevated white blood cell count; a palpable, tender mass in the right upper abdominal quadrant; disease duration of more than 72 h; and imaging studies indicating significant inflammatory changes in the gallbladder. Grade III (severe
acute cholecystitis) is defined as
acute cholecystitis with organ dysfunction.