ABSTRACT
A definitive diagnosis of acute cholecystitis (AC) can be challenging. One can choose to use a systematically defined Tokyo Guideline that divides symptoms into local signs, systemic signs, and a confirmatory test. Most clinicians, including emergency room physicians and surgeons, still rely heavily on an ultrasound as the first line to diagnose AC. It is easy to use, easily accessible, and avoids radiation exposure. Upon a diagnosis of AC, most patients will at some point need to undergo a cholecystectomy. The choice between a laparoscopic versus an open cholecystectomy seems rather obvious and intuitive to the modern-day surgeon but the actual level I evidence to support such a claim is surprisingly lacking. In summary, AC is a common surgical disease that requires early laparoscopic cholecystectomy once a definitive diagnosis has been made. An ideal confirmatory imaging study remains unknown and more studies are needed.
