Abstract A 23-year-old female underwent laparoscopic cholecystectomy complicated by gallstone and biliary spillage into the peritoneal cavity. Six years after surgery, ectopic gallstones were identified in the pelvis on sonography and MR imaging. Identification of ectopic gallstones is imperative for the expeditious diagnosis of the etiology and cause of the patient's symptoms prior to the development of more severe complications. Clinical sequelae of dropped gallstones include abscess formation, empyema, intra-abdominal adhesions, and draining sinus formation. Delay in diagnosis and treatment is often due to lack of awareness of intraoperative events and potential complications, unusual presentation of symptoms, and unexpected site of infection.