Acute cholecystitis is an exceedingly rare condition in young children; nevertheless, it should be considered while investigating an acute abdomen. We report a case of a five-month-old male who presented to the pediatric emergency department with inconsolable crying, decreased oral intake, vomiting, diarrhea, and a tender right upper quadrant of the abdomen. Laboratory studies revealed elevated gamma-glutamyl transferase and alkaline phosphatase and the abdominal ultrasound was suggestive of acute calculous cholecystitis. The patient was treated with intravenous hydration and antimicrobial therapy, avoiding the need for emergent cholecystectomy. A calcium bilirubinate calculus was observed in the feces but no etiology was found after extensive investigation. We aim to raise awareness of this diagnosis and the need for prompt initiation of therapy to avoid complications.

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