Background: Gallbladder (GB) cancer is not an uncommon cancer, however, has a geographical variation in incidence. Data on the presenting features and outcome are sparse from our part of the world. Hence, a retrospective analysis was undertaken to study the features. Patients and Methods: Adult patients diagnosed to have carcinoma of GB and admitted to two different University Hospitals in southern Pakistan between Nov 1998 and Sept 2003 were the subjects of the study. Results: One-hundred and eleven patients were diagnosed to have GB cancer, however, only 59 had biopsy-proven disease, and are the subjects of the study. There were 40 females and 19 males. The mean age was 53 ± 11.3 years. Fifty-five patients had adenocarcinoma and 4 had squamous cell carcinoma. Liver functions were deranged in a significant majority of patients; 34% had an SGPT more than 2 times the upper limit of the normal, 65% patients presented with an elevated serum bilirubin level, 80% presented with a high alkaline phosphatase, and 96% had a low albumin. 25% patients presented with acute renal failure. The median survival for the entire group was 10.2 months. Conclusion: Patients with GB carcinoma present with advanced stage disease. A vast majority of patients had abnormal liver or renal functions at the time of diagnosis precluding meaningful palliative treatment.