BACKGROUND: Though cholelithiasis and cholecystitis are common clinical problems, spontaneous cholecysto-cutaneous fistula is a rare complication of cholelithiasis in present-day practice. Very few cases have been reported in literature after 1950s. CASE REPORT: A 60-year-old male presented with pain and discharging sinus in the upper abdomen. Ultrasonography and computed tomography confirmed the presence of perforation of the gall bladder and cholecysto-cutaneous fistula. External opening of the fistula was overlying an old surgical scar. Less than five cases of spontaneous cholecysto-cutaneous fistula draining through an old surgical scar have been reported in literature. Initially, the patient was managed conservatively, followed by elective open cholecystectomy and excision of the fistula tract. CONCLUSIONS: Though very rare in the present era of advanced medical care, cholecysto-cutaneous fistula as a potential diagnosis should be kept in mind in patients presenting with acute upper abdomen pain and discharging sinus. High degree of suspicion is required for early diagnosis and treatment of this condition.