A case report of a 5-year retained common bile duct stent resulting in a stable jejunocolonic fistula

Introduction and importance: The implantation of common bile duct (CBD) stents is a routine intervention for the management of biliary obstructions and bile leakage. Although most implants are removed as scheduled or pass spontaneously, complications may occur, particularly when retained beyond the recommended duration. This case highlights the importance of patient education regarding non-permanent implants and the necessity of structured follow-up for timely stent removal. Case presentation: This case report describes a rare complication: a stable jejunocolonic fistula that was discovered 5 years after CBD stent implantation in a 50-year-old male with a history of Crohn’s disease. The patient presented to the emergency department with fever and abdominal pain, accompanied by septic findings. A computed tomography scan revealed micro-abscess formation within both kidneys and an unexpectedly dislodged CBD stent that formed a fistula between the colon and small intestine. Clinical discussion: Colonoscopy revealed a highly stenosed ileo-ascending anastomosis following past ileocecal resection and an adjacent fistula containing the stent. The stent was easily removed; however, due to severe stenosis of the anastomosis endoscopic, fistula closure was not attempted. As there were no signs of ileus, elective surgical exploration was recommended, but the patient opted for a watch-and-wait strategy with annual follow-up. After antibiotic treatment of the renal micro-abscesses which were deemed unrelated to the interenteric fistula, the patient was discharged in good condition. Conclusion: This case underscores the potential for late-onset complications associated with retained CBD stents and emphasizes the need for robust follow-up protocols and thorough patient education.