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Background: Gangrenous cholecystitis (GC) is considered a more severe form of acute cholecystitis. The risk factors associated with this condition and its impact on morbidity and mortality compared to non-gangrenous acute cholecystitis (NGAC) is poorly defined and based largely on older studies.Methods: Patients with histologically confirmed acute cholecystitis treated in a specialized tertiary hospital unit between 2005 and 2010 were identified from prospectively maintained database. Those with GC were then compared to those with NGAC.Results: 184 patients with NGAC and 106 patients with GC were identified. . The risk factors associated with GC included older age (P 0.001), diabetes (P 0.049), delay in operation (P <0.001), temperature of >38 oC (P <0.001), tachycardia (P 0.002), detection of muscle rigidity on examination (P 0.01), greater elevations in white-cell count (WCC) (P <0.001), C-reactive protein (CRP) (P 0.001), bilirubin (P 0.029) GGT (P <0.001), and elevations in urea and creatinine. (P <0.05). There were no overall differences in complications between the two groups. There was a lower incidence of common bile duct stones in the GC group (13% versus 25%% P = 0.017). GC was associated with increased mortality (P 0.017), but this was not an independent risk factor for mortality on multivariate analysis.Conclusion: Gangrenous cholecystitis has certain clinical features and associated laboratory findings that may help differentiate it from NGAC. It is not associated with overall increased complications when treatment is taken in a specialized unit.