Background. Acute cholecystitis in severely cardiopathic patient after major cardiac surgery represent a challenge for surgeons. Treatment with cholecystostomy could represent a chance for patients even if there are many topics of greatest debate about it: the technique of performing it (if transhepatic or transpapillary), the timing of optimal duration, the timing of drain removal, the need of further examinations before the removal as well as the timing for definitive surgery. We therefore deemed important to share our experience in the treatment of acute cholecystitis in a severe cardiopathic patient, while attempting to clarify all the major topics related to the management of percutaneous cholecystostomy through a literary review.Case presentation. A 58-year-old severly cardiopathic patient who had undergone surgery for hip replacement, developed an acute calcolous cholecystitis a few days after surgery to resolve which a percutaneous cholecystostomy was the chosen strategy. Two weeks after discharge, a cholangiography through the cholecystostomy and a MRI cholangiopancreatography revealed the presence of stones in the cystic duct and in the ductus choledochus. The definitive treatment was decided after consulting with a multidisciplinary team. An open cholecystectomy with simultaneous removal of the cholecystostomy, endoscopic removal of stones and sphincterotomy of the Oddi papilla was performed. The patient is currently healthy and his heart function is satisfactory. Conclusion. Although early cholecystectomy is the recommended choice for acute cholecystitis, a critically ill patients may benefit from a bridging therapy before definitive surgery. The multidisciplinary approach provided a safer solution for this frail patient.