Twenty-three patients with acute inflammation of the gallbladder with free perforation into the peritoneal cavity were admitted to the Beilinson Hospital, Tel Aviv, Israel, during the years 1960 to 1968. Gallbladder perforation was rare in our area prior to 1960, so that during the period that complication played no role in the indication for immediate operation. From 1960 on, however, a significant unexplained increase in the number of cases has occurred. Twenty of the 23 patients were over 50 years of age. More than half had no stones, and the majority were men. Twenty-one were operated upon without mortality. We therefore recommend early cholecystectomy in all older patients with acute cholecystitis.