[Cholecystitis in accident surgery]

Out of a large number of cholecystectomies four cases are reported. In some cases, the gallbladder was involved in the traumatic lesion itself but there are also cases, in which the cholecystitis developed independently of the primary lesion. Beside abdominal trauma which leads to a disruption of the organ wall we also see an inflammatory disease of the gallbladder after perforation during liver blind punction. In another case a patient with gall stone history developed acute cholecystitis after operative treatment of a collum femuris fracture. The fourth case shows acute cholecystitis which also arose after operative treatment of bone fracture in an acalculous bile vesicle. Acute cholecystitis after severe trauma not inflicting the organ itself is a severe, life threatening complication. One step to acute acalculous cholecystitis is the sludge formation in the gallbladder which can be recognized by ultrasonography. The pathogenetic mechanisms which lead to sludge phenomenon and later to acute cholecystitis are multifactorial. Some theories which try to explain this phenomenon are discussed. In each case the development of cholecystitis after trauma is a dangerous complication which urgently demands nonconservative treatment.