During the last 8 years 51 cases of acute post-traumatic or post-operative cholecystitis were observed in our intensive care unit. Twelve patients benefited from ultrasonically guided percutaneous cholecystostomy under television control. Diagnosis was made by ultrasonic examination and was based on the finding of an enlarged and tender gallbladder with an abnormally thick wall, sometimes with a double wall, and on the presence of sludge. Immediate cholangiography revealed spontaneous perforation in 4 patients who were operated upon at once. The other patients were treated by percutaneous cholecystostomy only with apparent success. The frequency, physiopathology, diagnosis and treatment of acute post-aggressive cholecystitis are discussed, with special reference to this new therapeutic approach.