Introduction Emphysematous cholecystitis is a rare gallbladder pathology characterized by gas accumulation in the gallbladder wall as a result of severe inflammation, mostly caused by bacteria known as Clostridium species. Case report This is a case report of a 59 year-old male diabetic, with typical anamnestic, clinical, ultrasonographic and radiological findings, pointing to acute cholecystitis of emphysematous form. Surgical and bacteriological procedures confirmed the preoperative findings. Conclusion Reliable findings considering clinical status, ultrasonographic and radiological differential diagnosis, adequate and quick preoperative preparation, cholecystectomy and drainage with appropriate antibiotic treatment and hyperbaric oxygenation, represent the basic principles in diagnostics and treatment of this disease.