Giant Gastric Phytobezoar Successfully Eradicated by Oral Intake Plus Endoscopic Injection of Coca-Cola:A Case Report

A phytobezoar is composed of indigestible fruit and vegetable fibers. Nonsurgical treatment had been reported for phytobezoar. Surgical intervention is considered necessary in cases with huge and impacted gastric phytobezoars. We report our experience in fragmenting a giant and solid phytobezoar using Coca-Cola solution intake per oral plus endoscopic injection. A 76-year-old man with a history of massive bleeding secondary to gastric ulcer underwent pyloroplasty without vagotomy. He was admitted because of postprandial colicky epigastric pain for 2 months. Upper gastrointestinal endoscopy showed a giant, blackish, solid bezoar with smooth-shiny surface occupying almost two third of lumen of stomach. The patient was given two cans of Coca-Cola every 6 hours for a total 4 days of treatment. Endoscopy two days after treatment, the bezoar was partially dissolved and softened. We broke the residual phytobezoar by one coin forcep with concomitant endoscopic injection of Coca-Cola solution into the phytobezoar. We repeated endoscopic injection of the Coca-Cola solution into these smaller bezoars. Follow-up endoscopy four days later showed disappearance of these bezoars except an ulcer at gastric angularis. There was no evidence of intestinal obstruction found in neither the small bowel nor the lower gastrointestinal series. We therefore conclude that this could be a safe and effective alternative method that can be performed in a medical ward thus avoiding possible surgery especially to these high-risk patients.