Although perforation of the acute gallbladder is not a common occurrence, a significant number of cases of acute cholecystitis will progress to perforation under conservative management. In 1949 Diffenbaugh et al1 collected from the literature 630 cases of perforation of the gallbladder among 5,272 cases of acute cholecystitis. This series summarized the experiences of 27 different surgeons and indicated an average incidence of 11.9% of perforations in acute cholecystitis. The incidence varied in different series from 2.5% to 25%. In 1934, Niemeier2 classified perforations of the gallbladder into three groups, namely: (1) acute perforation into the free peritoneal cavity, (2) subacute perforation with formation of a localized pericholecystic abscess, (3) chronic perforation with formation of an internal biliary fistula. The localized type of perforation is by far the most frequent. The other types of perforation are much less frequent. This paper presents a study of 21 cases of