Emphysematous cholecystitis is a dangerous form of acute cholecystitis. Preoperative early diagnosis can only be made radiologically and is based on the presence of gas in the gallbladder, the gallbladder wall, or in the pericholecystic space. Cholelithiasis occurs in only 50% of cases, more often in men, significantly more frequently in diabetics. Bacteriologically, organisms of the clostridia group are predominant, but bacteriology is altogether negative in ca. 50% of cases.