Useful of Tokyo guidelines in the diagnosis of acute cholecystitis. Anatomopathologie correlationship.

BACKGROUND

In the year 2007 a group of experts come together to discuss criteria for acute cholecystitis and to establish therapeutic guidelines and states of gravity in this disease.

OBJECTIVES

we correlated the criteria of the Tokyo Guidelines 2007 with the anatomopathology study of the surgical specimen.

SETTING

Service of Urgencies of the National Clinic Hospital in Córdoba, Argentine.

METHODS

We studied 324 patients (120 male and 204 female) older than 15 years and without limits of age with the criteria of acute cholecystitis a cord to the Tokyo guidelines 2007. 202 patients had a preoperative diagnosis of chronic cholecystitis and 89 of acute cholecystitis, all received cholecystectomy and studied the operative specimen in the anatomopathology department. Anatomopathology criteria for acute cholecystitis were the presence of polimorpho nuclear cells (PMN), for acute exacerbation of chronic cholecystitis the presence of PMN and monomorpho nuclear cells (MN), and for chronic cholecystitis the presence of MN with or without fibrosis.

RESULTS

This work showed 82,14% of sensitivity for the diagnostic criteria of Tokyo guidelines, 74,03% of specificity, and positive predictive value of 46%. With the Bayes Theorem the predictive value in Córdoba city was 18,49%.

CONCLUSION

There is an important difference in the specificity and positive predictive value between our work and the Tokyo guidelines for acute cholecystitis. There is an important group of patients in our work with acute exacerbation of chronic cholecystitis that is not classified in the diagnostic criteria for acute cholecystitis of Tokyo guidelines.