Table 1 Diagnostic criteria for acute cholecystitis according to the Tokyo Guidelines [11]

Mild (grade I)

Does not meet the criteria of “severe” or “moderate” acute cholecystitis. Can also be defined as acute cholecystitis in a healthy patient with no organ dysfunction and mild inflammatory changes in the gallbladder.

Moderate (grade II)

Associated with any one of the following conditions:

 1. Elevated white blood cell count (>18,000/mm³)

 2. Palpable tender mass in the right upper abdominal quadrant

 3. Duration of complaints > 72 h

 4. Marked local inflammation (gangrenous cholecystitis, pericholecystic abscess, hepatic abscess, biliary peritonitis, emphysematous cholecystitis)

Severe (grade III)

Associated with dysfunction of any of the following organs/systems:

 1. Cardiovascular dysfunction (hypotension requiring treatment with dopamine > 5 μg/kg/minute or any dose of norepinephrine)

 2. Neurological dysfunction (decreased level of consciousness)

 3. Respiratory dysfunction (PaO₂/FiO₂ ratio < 300)

 4. Renal dysfunction (oliguria, creatinine > 2.0 mg/dl)

 5. Hepatic dysfunction (PT-INR > 1.5)

 6. Hematological dysfunction (platelet count < 100,000/mm³)