Diagnosis of acalculous cholecystitis is often difficult and frequently delayed. In part, this is due to its preponderance in the difficult-to-examine critically ill patients with significant comorbidities. Early consideration of the disease and a high degree of suspicion are required to ensure prompt diagnosis. The delay in diagnosis and the ill patient population lead to a high rate of complication, such as gangrene or perforation (40% to 60%). The clinical findings are nonspecific and include fever, right upper quadrant abdominal pain, leukocytosis, and elevation of liver enzymes (LFTs) and bilirubin. Abdominal pain is the most consistent finding, but it is not always localized to the right upper quadrant; leukocytosis and elevated LFTs are present in approximately 75% of cases.