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Percutaneous nephrolithotomy (PCNL) is the surgical treatment of choice for large renal stones. Various complications have been reported following the PCNL technique. An infrequent yet severe surgical complication associated with PCNL is biliary peritonitis resulting from gallbladder injury during the procedure. In this article, we discuss the case of a patient who underwent PCNL. Following PCNL, the patient diagnosed with gallbladder perforation accompanied by biliary peritonitis. Furthermore, a literature review of the available evidence about clinical suspicion, diagnosis and treatment of this lethal complication is presented.