To the Editor.—Perforation of the gallbladder is a serious complication of acute cholecystitis. A rapid and reliable preoperative diagnostic method is desirable. Endoscopic retrograde cholangiography (ERC) was effective in the following case.
Report of a Case.—A 62-year-old man had abdominal pain for one week and fever, chills, and abdominal swelling for two days. His medical history included vagotomy and pyloroplasty for peptic ulcer disease, congestive heart failure, renal insufficiency, chronic obstructive pulmonary disease, and hepatic fibrosis with esophageal varices and encephalopathy. His rectal temperature was 37.7°C. The abdomen was mildly distended and tympanitic and diffuse tenderness was elicited. The white blood cell count was 16 700/mm3 (16.7×109/L). The alkaline phosphatase level was 231 U/L and the total bilirubin level was 2.5 mg/dL (43 μmol/L). The serum amylase level, urinalysis results, and a plain film of the abdomen were unremarkable. Cholelithiasis and free abdominal fluid were