Spilled unretrieved gallstones can cause rare but significant complications such as intraperitoneal abscesses, fistulas, intestinal obstruction and broncholithiasis. A 79 year old woman presented with a painful abscess on her right flank and MRI that revealed a large collection extending into the pararenal space. Her recent surgical history included a laparoscopic cholecystectomy for cholecystitis. She underwent an incision and drainage of the flank abscess which revealed a large cavity containing purulent exudate and several small gallstones. Gallstones are more likely to be spilled during laparoscopic cholecystectomy when compared to the open procedure. Steps during a laparoscopic cholecystectomy where the gallbladder can be perforated include when grasping the gallbladder, when dissecting the gallbladder off the liver and during retrieval through the umbilical port site. The risk of perforation is increased with an inflamed gallbladder. Spilled gallstones can have serious complications that will likely require an additional surgical procedure.