AIM:To evaluate the relationship between clinicalinformation(including age,laboratory data,and sonographicfindings)and severe complications,such as gangrene,perforation,or abscess,in patients with acute acalculouscholecystitis(AAC).METHODS:The medical records of patients hospitalizedfrom January1997 to December 2002 with a diagnosis ofacute cholecystitis were retrospectively reviewed to findthose with AAC,confirmed at operation or by histologicexamination.Data collected included age,sex,white bloodcell count,AST,total bilirubin,alkaline phosphatase,bacteriology,mortality,and sonographic findings.Thesonographic findings were recorded on a 3-point scale with1 point each for gallbladder distention,gallbladder wallthickness>3.5 mm,and sludge.The patients were dividedinto 2 groups based on the presence(group A)or absence(group B)of severe gallbladder complications,defined asperforation,gangrene,or abscess.RESULTS:There were 52 cases of AAC,accounting for 3.7% of all cases of acute cholecystitis.Males predominated.Most patients were diagnosed by ultrasonography(48 of52)or computed tomography(17 of 52).Severe gallbladdercomplications were present in 27 patients(52 %,group A)and absent in 25(group B).Six patients died with a mortalityof 12 %.Four of the 6 who died were in group A.Patients ingroup A were significantly older than those in group B(mean60.88 y vs.54.12 y,P=0.04)and had a significantly higherwhite blood cell count(mean 15 885.19 vs.9 948.40,P=0.0005).All the 6 patients who died had normal whiteblood cell counts with an elevated percentage of band forms.The most commonly cultured bacteria in both blood andbile were E..coli and Klebsiella pneumoniae.The cumulativesonographic points did not reliably distinguish between groupsA and B,even though group A tended to have more points.CONCLUSION: Older patients with a high white cell count are more likely to have severe gallbladder complications. In these patients, earlier surgical intervention should be considered if the sonographic findings support the diagnosis of AAC. AIM: To evaluate the relationship between clinical information (including age, laboratory data, and sonographic findings) and severe complications, such as gangrene, perforation, or abscess, in patients with acute acalculouscholecystitis (AAC) .METHODS: The medical records of patients hospitalized from January 1997 to December 2002 with a diagnosis ofacute cholecystitis were retrospectively reviewed to findthose with AAC, confirmed at operation or by histologicexamination. Data collected included age, sex, white blood count, AST, total bilirubin, alkaline phosphatase, bacteriology, mortality, and sonographic findings. findings were recorded on a 3-point scale with 1 point each for gallbladder distention, gallbladder wallthickness> 3.5 mm, and sludge. The patients were divided into 2 groups based on the presence (group A) or absence (group B) of severe gallbladder complications, defined asperforation, gangrene, or abscess.RESULTS: There were 52 cases of AAC, accounting for 3.7% of all cases of acute cholecyst Itis.Males predominated. Patients were diagnosed by ultrasonography (48 of 52) or computed tomography (17 of 52). Severe gallbladder implants were present in 27 patients (52%, group A) and absent in 25 With a mortality of 12%. Of the 6 who died were in group A. Patient ingroup A were significantly older than those in group B (mean 60.88 y vs. 4.12 y, P = 0.04) and had a significantly higherwhite blood cell count (mean 15 885.19 vs. 9 948.40, P = 0.0005). All the 6 patients who died had normal whiteblood cell counts with an elevated percentage of band forms. the most commonly cultured bacteria in both blood and capsule were E. coli and Klebsiella pneumoniae The cumulativesonographic points did not reliably distinguish between groups A and B, even though group A tended to have more points. CONCLUSION: Older patients with a high white cell count are more likely to have severe gallbladder complications. be considered if the sonographic findings support the diagnosis of AAC.