The management of acute calculus cholecystitis has evolved from conservative treatment with intra-venous antibiotics and analgesics to early cholecystectomy. Cholecystectomy is considered the definitive management of acute calculus cholecystitis and laparoscopic cholecystectomy is the gold standard in the management of acute calculus cholecystitis. The management of acute calculus cholecystitis can be divided into early laparoscopic cholecystectomy and delayed laparoscopic cholecystectomy. The current trend in the management of acute calculus cholecystitis is early laparoscopic cholecystectomy. The grey areas in the management of acute calculus cholecystitis include the timing of early laparoscopic cholecystectomy and the role of percutaneous cholecystostomy in high-risk patients. We have conducted this review article to look at the role of conservative treatment, the time for performing an early laparoscopic cholecystectomy and the role of percutaneous cholecystostomy.