The authors report four cases of acute cholecystitis occurring during intensive therapy. The patients, three male, among the four patients, were aged between 12 and 70 years. They had been hospitalised for surgery with a complicated and septic postoperative course (3 cases), or for acute decompensation of chronic respiratory failure (1 case). The complication developed within a period of 10 to 24 days. The clinical picture was that of an inflammatory obstruction with swelling of the right hypochrondrium. Treatment consisted of cholecystectomy in all four cases. Gall bladder lesions ranged from obstruction to total necrosis. In one case, calculi were found but could not be considered as having been solely responsible. The bile always had a frankly septic appearance. One patient died postoperatively as a result of septicaemia. The pathogenesis remains to be defined. Two components, mechanical and infectious, are most probable.