Introduction: Proximal stent migration can cause biliary obstruction and can act as a source for infection and stone formation with the potential for life-threatening complications. Stent removal rarely requires surgical intervention for removal as endoscopic techniques have advanced. We report a case of unusual proximal stent migration into the peritoneum managed surgically. A 77-year-old female with a past medical history of hypertension, diabetes melitus, cholecystectomy, choledocholithiasis status post multiple ERCPs, presented to the ER for jaundice and right upper quadrant abdominal pain. Patient was found to have elevated liver function tests, and MRCP revealed intrahepatic biliary ductal dilatation and unvisualized distal CBD, suggesting either stricture or compression by tumor. ERCP was performed and the guidewire was advanced through the ampulla. The CBD could not be cannulated with balloon catheter or sphincterotomy. ERCP was terminated and patient was referred to IR for PTC with biliary drain. One day later the patient developed sepsis with suspected CBD obstruction and biliary sepsis. She had another ERCP in which the CBD was able to be cannulated with sphincterotomy. Cholangiogram revealed a dilated biliary tree with a distal CBD stricture along the PTC catheter in place. The PTC catheter was removed and a pigtail stent was placed. She continued to have abdominal pain with an abdominal CT showing air within the biliary tree with intrahepatic bile duct dilatation. ERCP was performed again, during which the previously placed CBD stent was not seen and flouroexam showed proximal migration of the stent. At this point, multiple unsuccessful attempts were made to retrieve the migrated stent using balloon catheter, memory basket, rat tooth forceps, and snare. Surgery was consulted for biliary stent removal and biliary drain placement. During the procedure, bile was seen in the subcutaneous area and fascia of the linea alba. The anterior fascia of the rectus abdominus was opened at the level of the peritoneum, where the tip of the biliary stent was removed. A biliary drain was then placed percutaneously via the peripheral left intrahepatic duct. Over the next 5 days, the patient’s liver function tests improved, diet was advanced, and patient was discharged. Stent migration in itself is a rare entity which can cause significant morbidity, and stents that have migrated proximally are usually able to be retrieved on most occasions by endoscopy. Our patient proved to be difficult in that the stent had migrated through a previous placed PTC catheter tract into the peritoneum. This phenomenon has never been described in literature and should make gastroenterologists aware of the possibility and difficulty in retrieving stents that migrate in this nature. Surgical intervention should always be considered in this situation.