Tuberculosis is an infectious disease widely prevelant in the developing world. The resurgence of tuberculosis is on rise even in the developed world as the chemotherapy and steroid use is increasing. Indo gangetic belt is endemic for both the tuberculosis and gallbladder cancer. Gallbladder cancer although rare pathology carries a high rate of morbidity and mortality. Involvement of gallbladder in tubercular infection is rare. However, when involved there is a significant overlap of the clinical and radiological signs in both these patients. The treating physicians in these areas are always in therapeutic dilemma for the management of these patients. The other benign gallbladder pathologies mimicking the cancer further add on to the challenge in these patients. This article embarks upon the various challenges that a surgeon encounters in the management of these patients.