Unnoticed for 14 years: an asymptomatic forgotten common bile duct stent - a case report

Choledocholithiasis is the presence of gallstones within the common bile duct (CBD), affecting 10-20% of gallbladder stone patients. Endoscopic retrograde cholangiopancreatography (ERCP) with stent insertion is a common treatment of CBD obstruction and stenosis to maintain duct patency, with stents typically replaced within 3-6 months. However, prolonged stent presence can lead to complications such as pancreatitis and cholangitis. We report a rare case of a neglected CBD stent left in situ for 14 years without complications.

A 77-year-old female with controlled hypertension and diabetes presented to the hospital for a routine check-up. Physical examination was unremarkable except for mild scleral jaundice. She had a history of obstructive jaundice treated with ERCP and stent placement in 2010 but missed follow-ups for stent replacement. Laboratory tests revealed mildly elevated total bilirubin and low serum albumin. An abdominal ultrasound showed gallbladder sludge and a mildly dilated CBD. ERCP confirmed a dilated CBD and common hepatic duct stricture. A new plastic stent was placed, with follow-up ERCP scheduled every 6 months.

Forgotten biliary stents (FBS) are plastic stents left in place for more than a year. They can cause complications such as cholangitis, jaundice, stent migration, and pancreatitis. Elderly patients are more susceptible due to physical limitations and potentially inadequate follow-up. Our case highlights the unusual presentation of an asymptomatic FBS for 14 years.

This case emphasizes the importance of regular monitoring and timely stent replacement to prevent complications. Effective patient education and adherence to follow-up protocols are crucial in managing biliary stents.