The stent that time forgot: perforated small bowel diverticulitis seventy years in the making, a case report

Biliary stents are commonly used for strictures and obstruction, but can migrate distally in up to 20% of cases. While most are identified early, some remain silent for years before presenting with complications. We describe a rare case of a biliary stent that migrated and remained undetected for over 70 years in an 89-year-old woman with a history of cholecystectomy and common bile duct stenting in the 1950s. She presented with acute abdominal pain, nausea, and vomiting. Labs showed leukocytosis, renal dysfunction, and elevated alkaline phosphatase. Computed tomography imaging revealed small bowel thickening, extraluminal gas, and a radiopaque foreign body. Patient was found to have diffuse small bowel diverticulosis with localized perforation and adhesions; segmental resection confirmed diverticulitis with perforation and foreign body reaction around a retained biliary stent. This case highlights an exceptionally delayed complication of stent migration and the importance of comprehensive history-taking when evaluating elderly patients with atypical abdominal symptoms.