Acute cholecystitis is not an unusual sequela of chronic cholelithiasis, nor is its occurrence predictable. The elderly patient with acute cholecystitis faces an increased risk of death and illness. Prompt, remedial medical preparation followed by early surgical extirpation of the gallbladder (with common bile duct exploration where indicated) is the surgical treatment of choice. Cholecystostomy should be considered for those patients in whom a more extensive procedure is judged to be too hazardous. With Americans' intense interest in maintaining a vigorous, healthy, and youthful profile and their fear of dying, it is a most suitable protective health measure to advocate that all patients with calculous biliary tract disease be urged to have surgical intervention of this disease process before the complication of acute cholecystitis occurs. The risks of a cholecystectomy under elective conditions are low and the results are most gratifying.