AC is a common diagnosis, and the management of critically ill patients can be challenging with high rates of morbidity and mortality. While surgery is generally offered to “fit for surgery” patients, the management of critically ill patients is unclear. Percutaneous cholecystostomy has been used in such patients after failure of medical treatment. However, this procedure has been shown to be associated with unacceptably high rates of complications and mortality.This systematic review will give an overview of the existing data on the management of critically ill patients with AC. Directly comparing the outcomes of patients managed with cholecystectomy to those of similar patients managed with cholecystostomy may help facilitate the clinical decision-making.