Intrahepatic cholelithiasis refers to the formation of calculi in dilated intrahepatic ducts causing biliary obstruction and recurrent episodes of cholangitis which can be associated with complications such as sepsis. There is also an increased risk of cholangiocarcinoma with recurrent pyogenic cholangitis. Most documented cases have been predominantly in East and Southeast Asia, but with increasing travel and migration, we are now seeing more cases worldwide, including Australia. We describe a case of a 46-year-old Asian woman who presented to the ED with a history of epigastric pain radiating to her left upper quadrant. Her initial blood results demonstrated only an elevated CRP. Ultrasound abdomen revealed an intrahepatic duct dilation of the left lobe and a solid echogenic lesion in segment II. Subsequent CT and MRCP confirmed longstanding stable left lobe duct dilation with a 16mm dilation of the segment II duct and evidence of intrahepatic cholelithiasis. She underwent a laparoscopic left lateral segmentectomy and cholecystectomy with an uneventful post-operative recovery. Her final histopathology demonstrated significantly dilated hepatic ducts with chronic inflammatory infiltration. While intrahepatic cholelithiasis is managed with intravenous antibiotics in the acute setting, more definitive management is required to remove the calculi and dilate any strictures to prevent further obstruction. When compared to operative management, less invasive techniques such as endoscopic retrograde cholangiopancreatography or percutaneous cholecystostomy have been found to carry higher risk of incomplete stone clearance. Operative treatments have therefore been found to be a more favourable management option.