Emphysematous cholecystitis (EC) is an uncommon subdivision of acute cholecystitis. It is a lethal anaerobic infection, associated with a high mortality rate of 15-20% due to high prevalence of complications like gall bladder wall gangrene and perforation ¹. In spite of its higher complications and mortality, these patients usually present with nonspecific symptoms, are not critically sick and initially cannot be differentiated from the simple acute cholecystitis ¹. Patients with poorly controlled long-standing diabetes may not complain of classical pain in the right hypochondrium due to diabetic neuropathy ¹.