<p>Gallbladder polyps are a relatively common incidental finding during routine imaging studies. While the majority of these polyps are asymptomatic, a small subset can become symptomatic, leading to a variety of clinical presentations. We present a case of acute symptomatic polypoid lesion with macrolithiasis of the gallbladder initially presenting with equivocal clinical, laboratory, ultrasound and computer tomography findings. This case report aims to describe a patient with symptomatic gallbladder polyp and provide a review of the literature. A 56-year-old Moroccan male with no particular past medical history presented with recurrent mild upper right quadrant pain with intermittent epigastric discomfort after meals. Generally, there was not fever or jaundice. Ultrasonography of the abdomen detected a macrolithiasis with posterior shadowing and thin wall of gallbladder. Computed tomography showed evolution of a tissular mass lesion at the bottom of the gallbladder. This subsequently demonstrated a mild gallbladder pseudotumor. The patient underwent laparoscopic cholecystectomy, and pathological examination of the specimen confirmed a benign gallbladder polyp. Extemporaneous histology should be considered as to determine the various nature of polypoid lesions, particularly when ultrasound is equivocal or inconclusive, clinical and laboratory findings are non-specific. Hence symptomatic gallbladder polyps can present with variety of clinical manifestations.</p>