EFFECTIVENESS OF TOKYOGUIDELINES 2018 IN THE MANAGEMENT OF ACUTE CHOLANGITIS AND ACUTE CHOLECYSTITIS

Abstract

Acute biliary sepsis which includes Acute cholecystitis and Acute Cholangitis are life threatening surgical emergencies which needs early recognition and prompt institution of appropriate management strategies. Except for some well-known clinical signs like Murphys sign and Charcots triad there are no well-defined criteria for the diagnosis of above said biliary infections. Tokyo Guidelines 2018 is expert panel formulated Diagnostic and severity assessment criteria guidelines is the only guidelines available till date which aids in the diagnosis and management of the same. More number of patients can be diagnosed at an early stage of infection and appropriate treatment instituted at the earliest by using this guidelines, thus avoiding any foreseen complications. In this study, we have assessed the feasibility of using TG 18 guidelines in diagnosing and managing acute biliary infections in ESI Medical College and Hospital Rajajinagar, Bengaluru. Objective: To study the effectiveness of Tokyo Guidelines 2018 in diagnosing, assessing severity and management of acute cholecystitis and acute cholangitis. Material and Methods: All cases of acute cholangitis and acute cholecystitis admitted in ESI Medical College and Hospital Rajajinagar, Bengaluru. Patients who had been diagnosed as a case of acute Cholecystitis and acute cholangitis were followed up and assessed using the TG 18 guidelines criteria and the outcomes were analysed. The efficacy of Using the guidelines in our setup and reproducibility of guideline demanding parameters were analysed that were appropriate in our setup. Clinical details and lab and imaging findings were recorded using a well detailed clinical proforma that included detailed description of analysis of a case of acute cholecystitis and cholangitis. Also other contributing factors, clinical patterns ,presentation ,treatment outcomes were analysed in detail. Results: Acute Cholecystitis with most common etiology being gallstone disease is more common in females (66.6%),While Acute cholangitis is more common among elderly females(60%). 56.7 % patients diagnosed with Acute cholecystitis and 46.7% patients diagnosed with acute cholangitis presented to us in 24 - 72 hours of symptom onset. 33.3 % of cholecystitis and > 50% cholangitis patients were Diabetics Under treatment for the same.