A survey was prepared of 136 cases of laparotomy in patients with Behçet's disease and intestinal ulcers in Japan. The incidence of the disease is highest in males in the fourth and fifth decades. The ulcers are frequently found in the terminal ileum and the cecum. The ulcers are liable to perforate into the abdominal cavity, so that many patients require emergency operation. Resection of the ileocecal region or right half of the colon is the usual operation in the treatment of this disease. However, it is necessary to search for skip lesions, because multiple ulcers may be present. The incidence of postoperative complications and postoperative recurrence of ulcers is so high that supplementary management is often required.

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This is a report of a case of idiopathic perforation of the sigmoid colon, a rare condition, and a review of 65 cases collected from the Japanese literature including our own. The ratio of males to females was 42∶23, the ages ranged from 16 to 87 years, and 68% of the patients were in the sixth decade or older. The perforation sites were in the middle of the sigmoid colon in 43 cases, of which 79% were at the antimesenteric border, and in the rectosigmoid region in 2 cases. Several pathogenetic factors are considered to be responsible for this perforation, among which constipation and raised intra‐abdominal or intraluminal pressure may be most important. In the cases associated with constipation, differential diagnosis must be made by histologic examination. Free air under the diaphragm was noted on x‐ray in 46% of patients and leukopenia under 4000/mm3in 35% of the cases. Only 2 patients with confined perforation were diagnosed preoperatively by barium enema x‐rays. The overall mortality rate was 35%. Exteriorization or resection of the perforated site resulted in the best prognosis among the various operative procedures. There were 5 instances of colocutaneous fistula in 13 patients who underwent simple closure of the perforation.

A case of acute diffuse phlegmonous gastritis in a 54 year old man with an abrupt onset of upper abdominal pain, high fever and complete anorexia was presented. The stomach wall was remarkably thickened and rigid. Histologically there was massive infiltration of polymorphonuclear leukocytes in the submucosa and muscularis of the stomach wall. The lamina muscularis mucosae was fragmented by the numerous small focal abscesses.

Postoperative acute cholecystitis following surgery unrelated to the biliary tract is a rare complication. Of 49 cases of this disease collected from the Japanese literature, including 3 of our cases, the ratio of males to females was 42:7, the ages ranged from 31 to 83 years, and 82% of the patients had no biliary calculi. The antecedent operation was performed for cancer of the stomach in 30 patients (61%), and for another type of cancer in an additional 10. Several pathogenetic factors that differ from those responsible for ordinary cholecystitis are considered to be contributory to this disease, among which impairment of the circulation to the gallbladder may be one of the most important. The overall mortality rate of postoperative cholecystitis was 32%. Although cholecystectomy is the preferred treatment, local findings or the condition of the patient should be considered in the decision regarding therapy. Early surgical intervention should not be delayed in the elderly patient, because there was a significant difference between the average age of survivors and those who died.Acute cholecystitis developing in the early postoperative period following surgery unrelated to the biliary tract was described as a definite entity by Glenn [1] in 1947, although a few sporadic cases had been reported previously. Since that time, this condition has received wider attention, and J6nsson and Andersson [2] collected 346 cases, including 2 of their own in 1976. Recently, we treated 3 patients with postoperative acute cholecystitis in our institu-