Gangrene of the gallbladder.

Two hundred cases of acute cholecystitis were reviewed in order to distinguish the presentation of gangrenous cholecystitis from nongangrenous acute cholecystitis. An incidence of 21.5 per cent gangrenous cholecystitis was found. A review of history, physical examination, and laboratory results showed that the two groups were similar. The average age of those with gangrenous cholecystitis was 67 years, and there was a palpable mass in the right upper quadrant in 23 per cent of these patients. Of patients with gangrenous cholecystitis, fifty-one percent had a leukocyte count above 15,000. The postoperative complication rate was similar between the two groups, and the mortality rate of those with acute gangrenous cholecystitis was zero in our review. It is concluded that because of the clinical similarities between gangrenous cholecystitis and acute nongangrenous cholecystitis, and because of the high incidence of gangrenous cholecystitis in our group, early surgery is indicated for acute cholecystitis.