In Reply.—Our article on acalculous cholecystitis in the neonate1 was intended to alert the reader to the problem. The scant number of cases reported was hardly sufficient to make solid recommendations about definitive management. In our current era of intensive care, acute acalculous cholecystitis is becoming a recognized cause of sepsis in the severely stressed patient. (I have operated on two premature infants with gangrenous gallbladders.)
The infant described in our report1 was recovering, but we were quite concerned that we were dealing with a choledochal cyst. We were quite surprised intraoperatively to find the resolving cholecystitis. The abnormal histology of the specimen was striking.
Dr Coulter raises several good points, and we appreciate his instruction on the issue of right upper quadrant abdominal masses in the premature infant. I would like to assure him that we neither recommend nor perform cholecystectomy in every newborn with an