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Editorial
. 2020 Oct 28:60:304-307.
doi: 10.1016/j.amsu.2020.10.062. eCollection 2020 Dec.

Current grading of gall bladder cholecystitis and management guidelines: Is it sufficient?

Adel Elkbuli  1 , Evander Meneses  1 , Kyle Kinslow  1 , Dessy Boneva  1   2 , Mark McKenney  1   2
Affiliations
Editorial

Current grading of gall bladder cholecystitis and management guidelines: Is it sufficient?

Adel Elkbuli et al. Ann Med Surg (Lond). .

Abstract

•These two cases highlight the limitations in current grading systems, particularly in the context of gallbladder size.•We propose modifications to the PGS to include not only abnormal anatomy but instances of distorted gallbladder anatomy due to inflammation and/or the large to giant size in order to account for the increased risk of complications.•Both distorted gallbladder anatomy and giant gallbladder size can make laparoscopic cholecystectomy a challenge, and thus warrant contribution to overall clinical grade.•While the PGS, Tokyo Guidelines, and AAST grading scales are validated grading scales for acute cholecystitis, additional modifications can further characterize different types of acute cholecystitis to better guide patient management.

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Conflict of interest statement

Authors declare no competing interests.

Figures

Fig. 1
Fig. 1
(A) Laparoscopic imaging of the gallbladder showing suppurative inflammation and unrecognizable views/anatomy of the gallbladder. Gallbladder infundibulum (a), medial edge of liver (b), cystic duct (c). (B) Laparoscopic imaging of the gallbladder showing suppurative inflammation and unrecognizable views of the gallbladder. Pus (a), distorted gallbladder anatomy (b), medial edge of liver (c).
Fig. 2
Fig. 2
Intraoperative findings of a gangrenous and necrotic gallbladder with adhesions to the anterior abdominal wall (yellow arrow pointing to the gallbladder, red arrow pointing to adhesions, blue arrow pointing to the edge of the liver). (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)
Fig. 3
Fig. 3
Intraoperative findings of a gangrenous and necrotic gallbladder seen extending over the distal stomach causing mass effect (yellow arrow pointing to gallbladder, red arrow pointing to stomach). (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)
See this image and copyright information in PMC

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