This protocol applies to patients presenting with complicated acute calculous cholecystitis who are candidates for surgical intervention and have not refused surgery — a population where the management pathway differs substantially from non-operative approaches.

Clinical Scenario

The patient has complicated acute calculous cholecystitis and is suitable for surgery. Surgical eligibility and patient willingness to proceed are the defining factors that place this case within this specific management pathway.

Treatment Approach

Management centers on early laparoscopic cholecystectomy as the first-line surgical intervention, performed within a defined early time window, combined with an empiric antimicrobial regimen tailored to the patient's individual risk profile. Specific surgical decision criteria, procedural alternatives, and the complete antimicrobial framework are detailed in the full protocol.

References

DOI: 10.1186/s13017-020-00336-x

We recommend laparoscopic cholecystectomy as the first-line treatment for patients with ACC.
In the presence of adequate surgical expertise, we recommend ELC be performed as soon as possible, within 7 days from hospital admission and within 10 days from the onset of symptoms.
In complicated ACC, we recommend prescribing the antimicrobial regimen based on the presumed pathogens involved and the risk factors for major resistance patterns.

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Treatment of Complicated Acute Calculous Cholecystitis in a Patient Suitable for Surgery

Clinical Scenario

Treatment Approach

References