Patients with spinal cord injury (SCI) have an increased prevalence of cholecystitis. Neurologically intact patients with cholecystitis usually complain biliary colic of the right upper quadrant (RUQ). Because of the inability to localize visceral pain in patients with SCI, the pattern of symptoms are quite different. We reported a case of 48-year-old man with C5 incomplete tetraplegia (ASIA C) who presented an increased spasticity and vague pain of RUQ and later diagnosed as an acute acalculous cholecystitis. Antibiotics treatment and Percutaneous Transhepatic Gall Bladder Drainage (PTGBD) were performed. An open cholecystectomy was performed after the laparoscopic cholecystectomy which failed due to severe adhesion. Postoperatively, patient recovered well without complications. We suggested that even a vague abdominal pain shouldn't be underestimated in SCI patients.