Background: Acute cholecystitis is one of the most common surgical presentations worldwide. At the beginning of the COVID-19 pandemic, global recommendations suggested non-operative management or cholecystostomy for COVID-19 patients with acute cholecystitis to reduce the risk of peri-operative pulmonary complications, morbidity, and mortality. COVID-19 has been associated with increased thrombotic and haemorrhagic complications, along with hepatic inflammation due to cellular infection and cytopathy. Case presentation: A woman in her early 60s with COVID-19 (day five) presented with worsening biliary colic. Her inflammatory markers were elevated (C-reactive protein 47), and computed tomography (CT) confirmed acute cholecystitis. Due to her COVID-19 status deeming her a high anaesthetic risk she was admitted for a trial of intravenous antibiotics. On day two of her admission, she developed severe shoulder pain and haemodynamic instability. Emergency laparoscopy revealed a large subcapsular hepatic haematoma with haemoperitoneum and a gangrenous gallbladder. A cholecystectomy, liver abscess evacuation, and haemostasis of a liver laceration was performed. The patient required five units of packed red blood cells intraoperatively. Post-operative CT showed a liver laceration and large subcapsular haematoma involving greater than 50% of the liver’s surface area. This was managed conservatively, and she was discharged day five post-operatively. A follow-up ultrasound four weeks later showed a reduction in the size of the haematoma. Conclusion: This is a rare case of a patient with a severe complication from acute cholecystitis, likely secondary to concurrent COVID-19 infection and delayed surgical intervention.