Background Acute acalculous cholecystitis is a well recognized complic
ation of many acute illnesses. Ischaemia of the gallbladder seems to h
ave an important role in its pathogenesis. Methods Microangiography wa
s performed in 15 gallbladders immediately after cholecystectomy by in
fusing 10 per cent barium sulphate into the specimen. Five patients ha
d symptomatic gallstone disease, five had acute gallstone-associated c
holecystitis and five had acalculous cholecystitis. Sections for histo
logical examination were taken from adjacent sides of the microangiogr
aphy section. Filling of the vessels by contrast medium was compared w
ith histological findings. Results Microangiography of the gallbladder
in acute gallstone-associated cholecystitis showed strongly dilated a
rterioles and regular filling of the capillary network, whereas in aca
lculous cholecystitis the capillary filling was poor and irregular. Co
nclusion Disturbed microcirculation may play an important role in the
pathogenesis of acute acalculous cholecystitis.