This paper presents a survey of the experience gathered in the field of acute cholecystitis at the Sherbrooke University Hospital from 1969 to 1988. Diagnosis of acute cholecystitis in the absence of stone (according to histopathological criteria) was made in 26 cases. The relative number of such cases increased over the last 10 years of the study. Risk factors together with clinical and paraclinical data have been analyzed. Sonography is the diagnostic test of choice. Gall-bladder scanning is a useful adjuvant in cases of doubtful or negative sonography. Gangrene and/or perforation of the gall-bladder was reported in 57.7% of patients. Cholecystectomy was selectively performed in 23 of 24 cases when diagnosis was established in vivo. Cholecystectomy and percutaneous drainage are discussed.