Follicular cholecystitis is a rare occurrence which often involves extrahepatic biliary obstruction distal to the gallbladder. Therefore, the incidental finding of follicular cholecystitis in cholecystectomies warrants further investigations to exclude other causes of distal biliary tract obstruction. Furthermore, follicular cholecystitis is strongly associated with other simultaneous histological abnormalities in the gallbladder such as chronic cholecystitis and lymphocytic cholecystitis. We report the case of an 85-year-old female who presented with acute onset of epigastric and right upper quadrant pain, and an elevated lipase. Computed tomography of the abdomen and pelvis revealed features of acute pancreatitis without cholecystitis. Ultrasound of the abdomen showed cholelithiasis without sonographic evidence of cholecystitis. The patient underwent laparoscopic cholecystectomy upon improvement of her symptoms. Histopathology of the gallbladder demonstrated follicular cholecystitis. We present this case to discuss the unusual histology findings of follicular cholecystitis and a literature review of its associated conditions.