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Algorithm in the Management of Acute

Acute Calculous Cholecystitis Cholecystitis

NG Suction IV Fluids IV Analgesics IV Antibiotics

Improved Not Improved

Laparoscopic Good Risk Poor Risk


Or
Open
Cholecystectomy

Urgent Open
Cholecystectomy Interval
Cholecystostomy Electrohydraulic Percutaneous
Extracorporeal Aspiration under
Intraoperative Shock-wave Lithotripsy CT/UTZ
Cholangiogram

CBD Stones No CBD Stones

CBD Exploration Close

Complete Clearance Incomplete Clearance

Close

Impacted
Multiple Stones Uncertain
Ampullary Stone

Transduodenal
Choledochoduodenos Close with Large T
Sphincterotomy T
tomy tube
tube

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