Gallstones are a prevalent condition that can often be symptomatic, requiring multidisciplinary care and management. When symptomatic, gallstones can cause serious conditions such as acute cholecystitis, pancreatitis, and gallstone ileus. Acute cholecystitis carries a low mortality risk for most patients but can be significantly more deadly for older patients. There are two types of acute cholecystitis: calculous and acalculous, with the latter being more fatal and often occurring in critically ill patients. Various treatments are discussed, tracing the evolution from the first surgical percutaneous cholecystostomy to contemporary minimally invasive image-guided procedures to help patients with cholecystitis, cholelithiasis, and choledocholithiasis. Emphasis on the role of interventional radiology, particularly for patients who are too unstable for surgery or whose anatomy complicates endoscopic therapy, is further discussed, highlighting the collaboration needed among interventional radiology, gastroenterology, and surgical teams for effective patient management.