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Scoring System of Misawa et al for Severity of Inflammation in Calot's Triangle in a Patient with Cholecystitis

Purpose: To evaluate Calot's triangle in a patient undergoing a laparoscopic cholecystectomy using the grading system of Misawa et al.

Description

Misawa et al used a scoring system to describe inflammation in Calot's triangle, which impacts the outcome of laparoscopic cholecystectomy. This is a modification of the scheme proposed by Chang. The authors are from Jikei University in Tokyo, Japan.


Calot's triangle is defined as:

(1) superior: cystic artery

(2) medial: hepatic duct

(3) inferior: cystic duct

 

Inflammation

Identification of Structures in Calot's Triangle

Grade

Score

none

very easy

I

0

mild

very easy

II

1

moderate

easy to identify and separate

III

2

severe

identifiable but difficult to separate

IV

3

severe

difficult to identify and to separate

V

4

 

A person with Grade V (score 4) findings usually requires conversion to open surgery since the risk of bile duct damage is high during laparoscopic surgery.


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Specialty

Objective

ICD-10