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Biffl WL, Napolitano L, Weiss L, et al. Evidence-based, Cost-effective Management of Acute Cholecystitis: An Algorithm of the Journal of Trauma and Acute Care Surgery Emergency General Surgery Algorithms Working Group. J Trauma Acute Care Surg. 2024; in press.

This article supplied a well-organized and clearly written summary of recommended approaches for evaluation and management of patients with suspected acute cholecystitis.

The article emphasized that a thorough history and physical examination is a necessary first step. Laboratory studies, including liver function tests, were recommended. Elevated liver function tests may be an indication of associated choledocholithiasis. Right upper quadrant ultrasound examination is useful for confirmation of cholelithiasis and gallbladder inflammation.

Surgical consultation is recommended for any patient suspected of having acute cholecystitis. Data cited in the article showed that 78% of patients with signs and symptoms of acute cholecystitis who were discharged without surgical consultation required emergent readmission for cholecystectomy.

High-risk patients may be considered for alternative treatment approaches such as percutaneous or endoscopic drainage.

The article also provided a valuable review of data supporting various approaches for management of choledocholithiasis. Surgeons are encouraged to review the entire set of recommendations.