The cholecystitis without stones has been the subject of controversy for many years and a number of problems relating to it have still not been settled.
The present study was planned to know whether the parasite infestation of the biliary tree has any relationship with the etiology of the acalculous cholecystitis in southern part of .Korea around the Nak Dong river.
Clinical study was made on a series of 43 cases with acalculous cholecystitis from January 1971 to March 1976 at the department of surgery, St. Benedict Hospital, Busan, Korea. The results was as follows;
1) The incidence of. acalculous cholecystitis was 43 cases (21, 8%) of 197 cases who unde-rwent cholecystectomy, the incidence of cholecystectomy excluding cholecystomy´was 197 cases (68, 6%), of 287 total biliary tree operation cases.
2) The sex ratio of male to female was 1 to 1.4.
The number of cases from 21 years to 50 years was 34 cases of all 43 cases.
Thus most of the acalculous cholecystitis was the most active and productive age group.
3) According to the pathological classification, 7 cases C16.3%0) were acute cholecystitis; 1.case (2.3%) was acute and chronic cholecystitis, 1 case (2.3%), subacute cholecystitis; 34cases (79%) were chronic cholecystitis.
4) Abdominal pain was noted in all 43 cases. Indigestion, nausea, vomiting, fever & chills, jaundice were also observed.
On, physical findings, right upper abdominal tenderness were most prominant one which was noted in 36 cases (83,7%),
5) Serum bilirubin elevation above 1 mg% was noted in 16 cases (37, 2%) of 43 cases and alkaline phosphatase elevation in 17 cases (40,5%) of.42 cases.
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6) The X-ray of plain abdomen was suggestive of acute cholecystitis in all 7 cases in which relatively enlarged hazy gallbladder, like shadow with reflex ileus on right side of abdomen are noted. Abnormality of gallbladder visualization and gallbladder function was observed in 25 cases of 30 cases in which oral or LV, cholecystocliolangiography was performed.
7) Preoperative clonorchis sinensis; skin test was positive in 20 cases, (46,5%), During operation the bile was collected and sent to laboratory for parasite eggs. Liver fluke or their eggs were found in 20 cases (41,5%) and in these cases, preoperative clonorchis sinensis skin test was all positive.
Ascaris or their eggs was found in 12 cases (29, 5%),
8) Of 31 cases of chronic cholecystitis in which bile was cultured, 20 cases (64, 5%) yield a positive result.
E. coli was found in l1 cases (55%), staphylococcus albus in 5 cases (25%) and staphylo-coccus aureus 2 cases (10%).
Both chloramphenicol and gentamicin were most sensitive in 17 cases (70.8%) and.terra-mycin, next sensitive in 10 cases (41. 7%).
9) In 7 cases of acute cholecystitis, one cases (13.4%) had only a cholecystectomy and the other 6 cases (87.5%) cholecystectomy and eholedochostomy. In 34 cases of chronic cholecys-titis, 6 cases (17.6%) had only a cholecystectomy and the remaining 25 cases (73.5%) had cholecystectomy and cholecystectomy.
10) The operation mortality was 2.3% (one case), postoperative complication were noted in 18.6% (8 cases).
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