Introduction Acute alithiasic cholecystitis (AAC) is more frequent in severely ill patients, in the immediate postoperative period or in patients with extensive burns. Its morbimortality is quite high, with ischemia, infection and gall bladder stasis the main pathogenic determinants.

Methods A retrospective study including all cases of AAC diagnosed in our unit in the period of time between January 1997 and December 2007.

Results Four patients are included, all of them associated with viral or bacterial infection. They all started as abdominal pain localized in right hypochondrium, jaundice and darkened urine. Three patients also suffered from fever. Abdominal ultrasound showed thickening and hipervascularization of gall bladder wall in all cases. Clinical evolution was favourable in all cases without need for surgery.

Conclusions This illness is usually oligosymptomatic appearing during other systemic diseases of different severity. AAC must be suspected in all critically ill patients or suffering from severe infections who are presenting with abdominal pain with jaundice/darkened urine and hypertransaminasemia.