The gallbladder is an off-shoot of the extrahepatic biliary tree with a fundus, body and pouch connecting via a cystic duct to the common hepatic duct and therefore forming the common bile duct. Gallbladder mucosa is actively able to absorb water, chloride and bicarbonate. In hereditary conditions of red cell deformity, such as sickle cell anemia, spherocytosis, and thalassemia, there is increased red cell turnover and therefore increased throughput of hepatic bilirubin, leading to supersatured bile in the gallbladder and the increased potential for stone formation. Obesity, a family history of gallbladder disease, and the female gender predispose to stone formation in the pediatric age-group as for adults. Most gallstones should be removed together with the gallbladder. Mostly this is performed laparoscopically with a minimal stay in hospital. Acute cholecystitis leads to an obstruction at the neck of the gallbladder and failure of drainage with gallbladder distension and pus formation, or an empyema.