Chronic mesenteric ischemia (CMI) is a rare cause of abdominal pain with the potential for significant morbidity and mortality. An infrequently described complication of CMI is acalculous cholecystitis. Historically, acalculous cholecystitis is thought to be multifactorial and usually occurs in the setting of severe illness. In CMI, the etiology is more likely chronic ischemia to the gallbladder leading to inflammation. We present a case of acalculous cholecystitis that presented insidiously in a patient with CMI.