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ACUTE PNEUMOCHOLECYSTITIS, or acute gaseous cholecystitis, is a rarely encountered form of acute cholecystitis, characterized by the presence of gas in the lumen or wall of the acutely inflamed gallbladder. Its pathophysiology has been the subject of some conjecture, but most authors agree that the condition represents a form of acute cholecystitis. Most cases of acute cholecystitis are initially nonsuppurative, and cultures taken at the time of cholecystectomy usually fail to reveal any growth. However, in some instances, necrosis of the gallbladder mucosa ensues, lowering local tissue resistance and permitting invasion by gas-producing organisms. This combination of circumstances sets the stage for acute pneumocholecystitis. Cholelithiasis is not necessarily present, but gangrene of the gallbladder is frequent. The clinical condition is almost always severe, and the differential diagnosis includes acute pancreatitis, perforated peptic ulcer, gram-negative septicemia, pneumonia, and acute appendicitis. The increasing frequency of diagnosis of this condition results from a