Introduction: Complicated gallstone diseases like cholecystitis can arise as gallstones block portions of cystic duct systems. Typically, these patients present with severe, constant, several hour postprandial, right upper quadrant pain, accompanied by elevated liver enzymes, leukocytosis, gallbladder thickening and edema on imaging, and a positive Murphy’s sign.1-5 Objective: This patient’s presentation fell outside these parameters, yet still warranted consideration of cholecystitis as a possible cause for her abdominal and back pain. Case Presentation: 25-year-old Caucasian female, 2-months postpartum, presented to urgent care with a 1-week history of achy, bilateral, 7-8/10, mid-back pain following a banding, belt-like pattern, most severe posteriorly, only present at night, and waking her from sleep. Physical exam was unremarkable except for mild tenderness in the right upper quadrant, but Murphy’s sign was negative. Primary diagnosis was gastroesophageal reflux disease, with a differential diagnosis of biliary colic. Patient was referred to the emergency department for ultrasound and laboratory testing. Stones were noted on an otherwise typical gallbladder ultrasound. Complete blood count and comprehensive metabolic panel showed mildly elevated liver enzymes. Urinalysis had elevated erythrocytes/μL and leukocyte esterase. Patient was prescribed omeprazole, sent home, and instructed to monitor symptoms. She returned to the emergency department 2-hours later with 10/10 abdominal and back pain in a bilateral, banding pattern, equally painful anteriorly and posteriorly. She was given hydromorphone and sent for abdominal and pelvic computerized tomography with oral contrast, identifying an edematous gallbladder. Patient was admitted and scheduled for laparoscopic cholecystectomy the next day. Postoperatively, patient’s symptoms were completely resolved and she has remained symptom-free. Conclusion: While cholecystitis pain normally presents with right upper quadrant pain possibly radiating towards the right shoulder, an atypical bilateral location and banding pattern is possible. Early detection and subsequent cholecystectomy can limit time patients suffer from complicated gallstone diseases. However, not all patients with back pain should receive a cholecystitis work up as this presentation is rare and could result in unnecessary testing.