Duodenocolic Fistula following to Chronic Foreign Body Ingestion: A Rare Case Report

Foreign body ingestion is a common clinical presentation, but severe complications such as fistula formation are rare, particularly when involving the duodenum.We report an unusual case of a duodenocolic fistula caused by prolonged impaction of metallic foreign bodies in the second portion of the duodenum.A 47year-old man with a history of chronic amphetamine use presented with two weeks of melena, fatigue, and hemodynamic instability.Initial upper gastrointestinal endoscopy was inconclusive due to extensive clot burden.Repeat endoscopy revealed a metallic foreign body embedded in the second part of the duodenum.Contrast-enhanced computed tomography demonstrated a twisted metallic object composed of multiple wires causing transmural duodenal injury with fistulization into the hepatic flexure of the colon, accompanied by periduodenal inflammation and abscess formation.Colonoscopy confirmed the presence of a duodenocolic fistula.The patient underwent emergency laparotomy, during which the foreign body was removed, a right hemicolectomy was performed, and the duodenal defect was primarily repaired with omental reinforcement.The postoperative course was complicated by an anastomotic leak requiring reoperation and creation of a protective ileostomy.Following intensive care, antibiotic therapy, and nutritional support, the patient recovered and was discharged in stable condition.This case highlights a rare and life-threatening complication of foreign body ingestion and underscores the importance of early imaging, high clinical suspicion in highrisk populations, and individualized surgical management.Awareness of such atypical presentations may facilitate timely diagnosis and prevent catastrophic outcomes. Key Clinical MessageIn patients with obscure gastrointestinal bleeding and atypical urinary symptoms, foreign body ingestion should be considered even without clear history.Sharp metallic objects may cause delayed injury, fistula formation, and severe complications, requiring early imaging and prompt surgical management.