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dc.contributor.authorMiura, Fumihiko
dc.contributor.authorTakada, Tadahiro
dc.contributor.authorKawarada, Yoshifumi
dc.contributor.authorNimura, Yuji
dc.contributor.authorWada, Keita
dc.contributor.authorHirota, Masahiko
dc.contributor.authorNagino, Masato
dc.contributor.authorTsuyuguchi, Toshio
dc.contributor.authorMayumi, Toshihiko
dc.contributor.authorYoshida, Masahiro
dc.contributor.authorStrasberg, Steven M
dc.contributor.authorPitt, Henry A
dc.contributor.authorBelghiti, Jacques
dc.contributor.authorde Santibanes, Eduardo
dc.contributor.authorGadacz, Thomas R
dc.contributor.authorGouma, Dirk J
dc.contributor.authorFan, Sheung-Tat
dc.contributor.authorChen, Miin-Fu
dc.contributor.authorPadbury, Robert T
dc.contributor.authorBornman, Philippus C
dc.contributor.authorKim, Sun-Whe
dc.contributor.authorLiau, Kui-Hin
dc.contributor.authorBelli, Giulio
dc.contributor.authorDervenis, Christos
dc.date.accessioned2010-09-24T22:03:26Z
dc.date.available2010-09-24T22:03:26Z
dc.date.issued2007-01-25en_US
dc.identifier.citationJ Hepatobiliary Pancreat Surg. 2007 Jan 30; 14(1):27-34en_US
dc.identifier.issn0944-1166en_US
dc.identifier.pmid17252294en_US
dc.identifier.doi10.1007/s00534-006-1153-xen_US
dc.identifier.urihttp://hdl.handle.net/10675.2/137
dc.description.abstractDiagnostic and therapeutic strategies for acute biliary inflammation/infection (acute cholangitis and acute cholecystitis), according to severity grade, have not yet been established in the world. Therefore we formulated flowcharts for the management of acute biliary inflammation/infection in accordance with severity grade. For mild (grade I) acute cholangitis, medical treatment may be sufficient/appropriate. For moderate (grade II) acute cholangitis, early biliary drainage should be performed. For severe (grade III) acute cholangitis, appropriate organ support such as ventilatory/circulatory management is required. After hemodynamic stabilization is achieved, urgent endoscopic or percutaneous transhepatic biliary drainage should be performed. For patients with acute cholangitis of any grade of severity, treatment for the underlying etiology, including endoscopic, percutaneous, or surgical treatment should be performed after the patient's general condition has improved. For patients with mild (grade I) cholecystitis, early laparoscopic cholecystectomy is the preferred treatment. For patients with moderate (grade II) acute cholecystitis, early laparoscopic or open cholecystectomy is preferred. In patients with extensive local inflammation, elective cholecystectomy is recommended after initial management with percutaneous gallbladder drainage and/or cholecystostomy. For the patient with severe (grade III) acute cholecystitis, multiorgan support is a critical part of management. Biliary peritonitis due to perforation of the gallbladder is an indication for urgent cholecystectomy and/or drainage. Delayed elective cholecystectomy may be performed after initial treatment with gallbladder drainage and improvement of the patient's general medical condition.
dc.rightsThe PMC Open Access Subset is a relatively small part of the total collection of articles in PMC. Articles in the PMC Open Access Subset are still protected by copyright, but are made available under a Creative Commons or similar license that generally allows more liberal redistribution and reuse than a traditional copyrighted work. Please refer to the license statement in each article for specific terms of use. The license terms are not identical for all articles in this subset.en_US
dc.subject.meshAcute Diseaseen_US
dc.subject.meshAlgorithmsen_US
dc.subject.meshCholangitis / diagnosis / therapyen_US
dc.subject.meshCholecystitis, Acute / diagnosis / therapyen_US
dc.subject.meshDiagnosis, Differentialen_US
dc.subject.meshHumansen_US
dc.subject.meshTokyoen_US
dc.titleFlowcharts for the diagnosis and treatment of acute cholangitis and cholecystitis: Tokyo Guidelines.en_US
dc.typeJournal Articleen_US
dc.typePractice Guidelineen_US
dc.typeResearch Support, Non-U.S. Gov'ten_US
dc.identifier.pmcidPMC2784508en_US
dc.contributor.corporatenameDepartment of Surgeryen_US
refterms.dateFOA2019-04-09T16:26:19Z
html.description.abstractDiagnostic and therapeutic strategies for acute biliary inflammation/infection (acute cholangitis and acute cholecystitis), according to severity grade, have not yet been established in the world. Therefore we formulated flowcharts for the management of acute biliary inflammation/infection in accordance with severity grade. For mild (grade I) acute cholangitis, medical treatment may be sufficient/appropriate. For moderate (grade II) acute cholangitis, early biliary drainage should be performed. For severe (grade III) acute cholangitis, appropriate organ support such as ventilatory/circulatory management is required. After hemodynamic stabilization is achieved, urgent endoscopic or percutaneous transhepatic biliary drainage should be performed. For patients with acute cholangitis of any grade of severity, treatment for the underlying etiology, including endoscopic, percutaneous, or surgical treatment should be performed after the patient's general condition has improved. For patients with mild (grade I) cholecystitis, early laparoscopic cholecystectomy is the preferred treatment. For patients with moderate (grade II) acute cholecystitis, early laparoscopic or open cholecystectomy is preferred. In patients with extensive local inflammation, elective cholecystectomy is recommended after initial management with percutaneous gallbladder drainage and/or cholecystostomy. For the patient with severe (grade III) acute cholecystitis, multiorgan support is a critical part of management. Biliary peritonitis due to perforation of the gallbladder is an indication for urgent cholecystectomy and/or drainage. Delayed elective cholecystectomy may be performed after initial treatment with gallbladder drainage and improvement of the patient's general medical condition.


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