Most gall bladders surgically removed contain stones. The incidence of cholelithiasis in published cholecystectomy series ranges from 75% to 100%, with an average for the aggregate of 92.5%.1 Only occasionally has stonefree cholecystitis been considered separately.* However, acute inflammation, and even gangrene, of the gall bladder can occur in the absence of calculi. The pathogenesis of this form of cholecystitis is often obscure, since acute cholecystitis is generally attributed to blockage of the cystic duct by a gallstone.
The present study was undertaken in a search for clues to the etiology of acute stoneless cholecystitis and to emphasize certain features apparently peculiar to this form of gall-bladder disease. The impression gained is not in accord with the oft-quoted statement that "cholecystitis without stones seems to belong to a region on the borderline between functional and organic disease."2
A total of 542 cholecystectomies were performed during the five