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Aiming at improving the diagnostic accuracy not to overlook irreversible cholecystitis such as gangrenous cholecystitis, 21 cases operated on for acute cholecystitis at the hospital in a recent 6-year period were studied for each histological finding of the excised specimens in terms of diagnostic accuracy.The results were: In judging the degree of inflammation in acute cholecystitis leukocytes counts at the first visit, characteristics of the gallbladder wall by ultrasonography and serial-ultrasonography, swelling of the gallbladder by serial-ultrasonography, and observation of debris changes were useful. Such a case, in which gallbladder swelling increases, debris in the gallbladder does not disappear, and irregular gallbladder wall is observed, is strongly indicated to be of gangrenous cholecystitis.

Various diseases can cause biliary stricture, and in not a few cases, we have difficulties in the differentiation between the benignancy and malignancy.Here we describe a case of localized biliarys tricture, in which preoperative percutaneous transhepatic cholangioscopy (PTCS) could almost deny a possible malignancy. The case was a 54-year-old female who was admitted to a hospital with the complaints of nausea and vomiting, and then referred to our hospital because of choledocholithiasis and stricture of common bile duct pointed out by ERCP. Echography, CT, and angiography failed to reveal any clear images of a tumor. Through the fistula of PTCD, PTCS was carried out and the stricture could be directly seen. From the observation and biopsy results, a possibility of malignant disease could be practically denied preoperatively. The stricture was amputated at the hepatic site and bile duct-jejunum anastomosis was performed, because perioperative prompt histologic findings of the stricture offered a diagnosis of benign one. In benign bile duct strictures we often have difficulties in differentiation from malignant strictures, in that PTCS as well as perioperative prompt histologic examination appears valuable in final decision-making of diagnosis.