Background: Cholelithiasis in children was reported about three centuries back and remained relatively uncommon in the past but now it is evolving and ever-increasing in frequency. We aimed to study the clinical presentation, predisposing factors, and treatment outcome of cholelithiasis in children in western Odisha. Methodology: The present prospective study was conducted on 38 patients less than 18 years old, with ultrasound proved cholelithiasis. Data were reviewed concerning patient demographic profile, clinical history including risk factors, imaging studies, operative techniques, postoperative complications, and treatment outcome. Results: 38 children (14 boys and 24 girls) with cholelithiasis were evaluated and treated during the study period and the mean age was 14.25±3.01 years (range 5 to 18 years). 44.73% of children (n = 17) belonged to rural backgrounds and the rest to urban setups, and 23(60.52%) of patients belonged to the Hindu religion. In 63.15% of patients, no risk factor could be traced. 73.68% of children had multiple gallstones. 28(73.68%) patients underwent laparoscopic cholecystectomy. The average duration of hospital stay was 4.42 days. No major intraoperative or postoperative complications could be detected. Conclusions: In this region of the country most of the children had no risk factors identified for cholelithiasis. Girls with middle socioeconomic status and urban areas belonging to the Hindu religion were more affected by the disease. In view of the high incidence of serious complications of gallstones in children and because of longer life expectancy we also recommend that expectant management of gallstones may not be safe and hence laparoscopic cholecystectomy must be done even in asymptomatic cholelithiasis.