<p>This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</p> <p>The management of patients with acute calculous cholecystitis has changed during recent years. The
etiology of acute cholecystitis is still not fully understood. Infection of bile is relatively unimportant since
bile and gallbladder wall cultures are sterile in many patients with acute cholecystitis. Ultrasonography
is first choice for diagnosis of acute cholecystitis and cholescintigraphy is second best. Percutaneous
puncture of the gallbladder that can be used for therapeutic drainage has also diagnostic qualities. Early
cholecystectomy under antibiotic prophylaxis is the treatment of choice, and has been shown to be
superior to delayed surgery in several prospective trials. Mortality can be as low as 0.5% in patients
younger than 70–80 years of age, but a high mortality has been reported in octogenerians. Selective
intraoperative cholangiography is now generally accepted and no advantage of routine cholangiography
was shown in clinical trials. Percutaneous cholecystostomy can be successfully performed under
ultrasound guidance and has a place in the treatment of severely ill patients with acute cholecystitis.
Laparoscopic cholecystectomy can be done safely in patients with acute cholecystitis, but extensive
experience with this technique is necessary. Endoscopic retrograde drainage of the gallbladder by
introduction of a catheter in the cystic duct is feasible but data are still scarce.</p>
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HPB Surg. 1992; 6(2):69-78