Constrictive pericarditis is usually a symmetrical scarring process that produces uniform restriction of the filling of all heart chambers. Tuberculosis was formerly the leading cause of constrictive pericarditis in Western, especially in developing countries. In this illness, symptoms secondary to systemic venous congestion such as edema, abdominal swelling and discomfort due to ascites and passive hepatic congestion may be predominant. Vague, abdominal symptoms such postprandial fullness, dyspepsia, flatulence, and anorexia may also present. Chronic constrictive pericarditis may present difficulties in diagnosis with atypical signs and symptoms. We present a case of constrictive pericarditis with refractory heart failure, who was operated with a misdiagnosis of cholecystitis, and review the diagnostic strategies.