Background/Aims: Percutaneous cholecystostomy for decompression and drainage of the gallbladder is indicated when the patient is elderly or suffers from an inflatnmatory process of the gallbladder and is unable to tolerate an operation. To evaluate the role of percutaneous cholecystostomy in the management of acute cholecystitis in the high risk patients, we reviewed our experiences. Methods: Fourteen high risk critically ill patients with acute cholecystitis underwent percutaneous cholecystostomy from January, 1994 to July, 1995 using 8.'7 Fr pigtail catheter under real-time ultrasound and fluoroscopic guidance. Results: The clinical conditions of 14 patients improved after percutaneous cholecystostomy without technical complications. Eight patients subsequently underwent successful elective cholecystectomy after improvement in their medical condition, but one patient who underwent surgery died 10 days after surgery due to gastric varix bleeding which was not related to the gallbladder catheter. The remaining six patients had resolution of acute cholecystitis but did not undergo elective operation because of their poor medical conditions (three in calculous disease) and restoration of gallbladder function(three in acalculous disease). Conclusions: Percutaneous cholecystostomy may be used as an initial life saving procedure for critically I]1 patients with acute cholecystitis, and serves as a definitive procedure for patients considered to be at high operative risk and who have no residual stones. (Korean J Gastroenterol 1997; 29:515-521)