Acute cholecystitis (AC) is mainly caused by stones in the gall bladder. Although cholescintigraphy has the highest sensitivity (97%) and specificity (94%) for AC, ultrasound is the most commonly used technique in confirming the diagnosis. Laparoscopic cholecystectomy is the recom­mended treatment of choice; however, in high-risk patients percutaneous gall bladder drainage is an attractive alter­native approach to avoid lesions to the common bile duct. To avoid serious bleeding incidences, it is imperative to pause anticoagulation therapy prior to gall bladder drainage.