Introduction Perforation of the gallbladder is a benign and common complication during laparoscopic cholecystectomy. However, it may result in stone spilling, which potentially can lead to serious postoperative complications. 

Case report A 70-year-old male underwent laparoscopic cholecystectomy for acute cholecystitis. The procedure was complicated by perforation of the gallbladder and spilling of gallstones. More than a year after the procedure, the patient developed subcutaneous abscesses containing some of the spilled stones, a computed tomography revealed a complex intraabdominal and intrathoracic fistula with communication from the abdominal cavity to pleura and ultrasonic imaging found a lost gallstone in the thorax. After two years, the patient developed pleural empyema and sepsis secondary to the condition. Presently, the patient awaits surgery for the fistula and empyema. 

Conclusion Proper care should be taken to avoid stone spilling during laparoscopic cholecystectomy. However, if perforation and stone spilling occur, all visible stones should be removed during the procedure and the complication should be noted in the medical records. Furthermore, the patient should be thoroughly informed. This may help accelerate diagnosis if the patient later suffers from a complication related to lost stones.