Acute acalculous cholecystitis (AAC) is a lethal complication, which can be found in patients with major trauma. It isuncommon and diffi cult to diagnose in intensive care units. Rapid improvement may be expected when AAC is diagnosedcorrectly and cholecystectomy is performed on time. We report a critically ill patient with thoracic spinal transection andmultiple fractures of the ribs, complicated by AAC in the intensive care unit. His clinical condition is not suitable for undergoingsurgery; therefore, the patient was successfully treated with percutaneous cholecystostomy. Percutaneous cholecystostomyis a safe treatment for critical patients with traumatic injury complicated by AAC.