A 63-year-old man with a history of a conventional cholecystectomy was referred to our department for an incisional subcostal hernia and chronic back pain. Physical examination also showed an umbilical hernia and diastasis recti measuring 6 cm that was confirmed with a computed tomography scan. Subcutaneous video-endoscopic repair was done repairing all defects simultaneously.

Highlights Thoracic complications after spilled gallstones are rare Thoracic consequences of a spilled gallstone should be considered in every patient with thoracic symptoms and history of cholecystectomy Dropped stones are associated with a low risk of complications but of high morbidity, especially in immunosuppressed patients Documentation and a high index of suspicious are fundamental to speed diagnosis and treatment

Bouveret’s syndrome is a complication of cholelithiasis that presents with gastric outlet obstruction due to an impacted gallstone in the duodenum following cholecystoduodenal fistula. This is a rare presentation of biliary-enteric fistula; therefore, there are no standardized guidelines for the management of this disease. We present a case of a patient with Bouveret’s syndrome managed with laparoscopic surgery after an unsuccessful attempt of endoscopic removal.

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