[Our experience with emergency surgical treatment of acute cholecystitis]

A clinical series of 580 patents (318, F, 199 M) personally observed at the Emergency Surgery and First Aid Division of the Fatebenefratelli and Ophthalmic Hospital Board of Milan between 1975 and 1980, and suffering from acute inflammation of the bile ways (gall bladder empyemas, acute cholecystitis, gangrene of the gall bladder, haemobilia due to gall bladder puncture), has been examined. Of these patients, 558 were subjected to surgery between 12 hours and 6 days after admittance. Operated patients are subdivided into 4 groups on the basis of their anatomo-pathological form and the average time interval between admittance and intervention. Critical examination shows that their behaviour with respect to acute inflammatory forms of the gall bladder can be split up as follows: 1) immediate surgery (within 12 hours) for empyematous and/or punctured forms; 2) emergency surgery (within 2 days of admittance) for cases with certain diagnosis backed up by historical and X-ray data pointing to calculosis of the gall bladder; 3) early surgery (within 3 days) for cases with certain diagnosis but without prior X-ray documentation; 4) deferred surgical intervention (within 6 days) for patients without X-ray documentation and in whom immediate medical treatment leads to a rapid improvement in the clinical picture. The very good clinical results obtained and the observation of a low mortality and morbility index (comparable to those of surgery of choice) suggest that early surgery is certainly the therapy of choice when dealing with acute cholecystitis.