Over an 18-month period, 31 cholecystectomies were performed for empyema of the gall bladder. Analysis of these 31 cases showed that clinical features referable to the diagnosis and seriousness of this condition were few. The presence of a gall bladder mass was detected in only 35% of patients. In adopting a policy of early cholecystectomy for patients admitted for acute gall bladder disease, a low mortality rate of 3.2% was achieved for this group of patients with empyema of the gall bladder. Based on these results, we found that empyema of the gall bladder is another good reason to support early cholecystectomy.