Gastric phytobezoar presenting one week after an uneventful robotic hiatal hernia repair: a case of successful dissolution with Coca-Cola beverage

Camille Mai-Phuong Tran Quang; Mrinalini Alla; Nana Marfo; Chloe Bodden; Martine A. Louis

doi:10.18203/2349-2902.isj20252691

Authors

Camille Mai-Phuong Tran Quang Department of Surgery, Flushing Hospital Medical Center, Flushing, New York, USA
Mrinalini Alla Department of Surgery, Flushing Hospital Medical Center, Flushing, New York, USA
Nana Marfo Department of Surgery, Flushing Hospital Medical Center, Flushing, New York, USA
Chloe Bodden Department of Surgery, Flushing Hospital Medical Center, Flushing, New York, USA
Martine A. Louis Department of Surgery, Flushing Hospital Medical Center, Flushing, New York, USA

DOI:

https://doi.org/10.18203/2349-2902.isj20252691

Keywords:

Gastric bezoar, Chemical dissolution, Cola-cola

Abstract

Bezoars are conglomerates of undigested foreign material that are not commonly found in the stomach or intestines. Although there are different classifications of bezoars, 40% are due to phytobezoars which are made of indigestible fibers. Predisposing factors such as gastric surgery, medication or other medical conditions may aid in the development of bezoars. Here we describe a case of a gastric phytobezoar in a patient just one week after a robotic hiatal hernia repair, successfully treated by chemical dissolution using Coca-Cola. The patient was admitted to the surgical services with nasogastric decompression, intravenous resuscitation and antibiotics after an abdominal-pelvic computed tomography demonstrated a large amount of food in the stomach. Subsequent kidneys, ureters, and bladder (KUB) images showed a persistent large amount of retained food, and the patient underwent an Esophagogastroduodenoscopy (EGD) on day 3 of admission. Coca-Cola was infused on day 5 and day 6 of admission and the subsequent KUB showed improved gastric distension. Patient underwent another EGD on day 7 of admission which revealed an empty stomach. She was then advanced to a full liquid diet, had a bowel movement and was discharged on day 8 of admission. Bezoars are conglomerates of undigested material with gastric surgery being cited as the most common risk factor. However, it is not commonly found after a hiatal hernia repair. Chemical dissolution with Coca-Cola is a successful non-invasive alternative to the surgical removal of the phytobezoar.

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References

Kadian RS, Rose JF, Mann NS. Gastric bezoars-spontaneous resolution. Am J Gastroenterol. 2011;70(1):79-82.

Mihai C, Mihai B, Drug V, Cijevschi Prelipcean C. Gastric bezoars--diagnostic and therapeutic challenges. J Gastrointestinal Liver Dis. 2013;224(1):111.

Ertuğrul G, Ertuğrul G, Coşkun, Sevinç, Ertuğrul, Toydemir T. Treatment of gastric phytobezoars with Coca-Cola® given via oral route: a case report. IJGM. 2012;7:157. DOI: https://doi.org/10.2147/IJGM.S29453

Khalil H, Parmar C, Sufi P. Conservative managing of bezoar in giant hiatus hernia causing gastric outlet obstruction during the COVID-19 Pandemic. Obes Surg. 2021;31(6):2780-2. DOI: https://doi.org/10.1007/s11695-021-05250-y

Iwamuro M, Okada H, Matsueda K, Inaba T, Kusumoto C, Imagawa A, et al. Review of the diagnosis and management of gastrointestinal bezoars. WJGE. 2015;7(4):336. DOI: https://doi.org/10.4253/wjge.v7.i4.336

Hyams JS, Kay M, editors. Pediatric gastrointestinal and liver disease. Elsevier. 2021.

Kramer SJ, Pochapin MB. Gastric phytobezoar dissolution with ingestion of diet coke and cellulase. Gastroenterol Hepatol. 2012;8(11):770.

Lin YX, Wang SJ, Liang HS, Lin S, Bian LY, Ding J, et al. Clinical analysis of the curative effect of a transnasal ileus tube in the treatment of small bowel obstruction caused by a phytobezoar. Gastroenterol Res Pract. 2020;20:1-8. DOI: https://doi.org/10.1155/2020/4295024

Dhakal OP, Dhakal M, Bhandari D. Phytobezoar leading to gastric outlet obstruction in a patient with diabetes. BMJ Case Reports. 2014;13:200661. DOI: https://doi.org/10.1136/bcr-2013-200661

Mahir S, Salih AM, Ahmed OF, Kakamad FH, Salih RQ, Mohammed SH, et al. Giant phytobezoar; an unusual cause of gastric outlet obstruction: A case report with literature review. Int J Surg Case Reports. 2020;67:154-6. DOI: https://doi.org/10.1016/j.ijscr.2020.02.012

Zwicky S, Inauen W, Pfefferkorn U. Case Report: Phytobezoar Causing Gastric Outlet Obstruction as a Late Complication After Biliopancreatic Diversion with Duodenal Switch. Obes Surg. 2020;30(8):3233-5. DOI: https://doi.org/10.1007/s11695-020-04531-2

Paschos KA, Chatzigeorgiadis A. Pathophysiological and clinical aspects of the diagnosis and treatment of bezoars. Ann Gastroenterol. 2019;32(3):224. DOI: https://doi.org/10.20524/aog.2019.0370

Dikicier E. Intestinal obstruction due to phytobezoars: An update. WJCC. 2015;3(8):721. DOI: https://doi.org/10.12998/wjcc.v3.i8.721

Shah D, Ali Q, Bernier K, Gutierrez VA, Harper L. Successful Dissolution of a Large Gastric Phytobezoar Through Nonsurgical and Nonendoscopic Fragmentation. ACG Case Rep J. 2023;10(9):1141. DOI: https://doi.org/10.14309/crj.0000000000001141

Ahn YH, Maturu P, Steinheber FU, Goldman JM. Association of diabetes mellitus with gastric bezoar formation. Arch Intern Med. 1987;147(3):527-8. DOI: https://doi.org/10.1001/archinte.1987.00370030131025

Erzurumlu K. Gastrointestinal bezoars: A retrospective analysis of 34 cases. WJG. 2005;11(12):1813. DOI: https://doi.org/10.3748/wjg.v11.i12.1813

Tabesh E, Dehghan A, Tahmasebi M, Javadi N. Gastric phytobezoars as a very unusual cause of gastric outlet obstruction. J Res Med Sci. 2021;26(1):25. DOI: https://doi.org/10.4103/jrms.JRMS_115_20

Rancourt M, Paré A, Comeau É. Intraoesophageal migration of Teflon pledgets used for hiatal hernia repair: a serious adverse event. BMJ Case Rep. 2019;12(4):224383. DOI: https://doi.org/10.1136/bcr-2018-224383

Lu BY, Zeng ZY, Zhang DJ. Successful treatment of small bowel phytobezoar using double balloon enterolithotripsy combined with sequential catharsis: A case report. World J Radiol. 2024;16(11):683-8. DOI: https://doi.org/10.4329/wjr.v16.i11.683

Ladas SD, Triantafyllou K, Tzathas C, Tassios P, Rokkas T, Raptis SA. Gastric phytobezoars may be treated by nasogastric Coca-Cola lavage. Euro J Gastroenterol Hepatol. 2022;14(7):801-3. DOI: https://doi.org/10.1097/00042737-200207000-00017

Kurt M, Posul E, Yilmaz B, Korkmaz U. Endoscopic removal of gastric bezoars: an easy technique. Gastrointestinal Endosc. 2014;80(5):895-6. DOI: https://doi.org/10.1016/j.gie.2014.01.052

McKechnie J. Gastroscopic removal of a phytobezoar. Gastroenterology. 2022;62(5):1047-51. DOI: https://doi.org/10.1016/S0016-5085(72)80123-9

Gaya J, Barranco L, Llompart A, Reyes J, Obrador A. Persimmon bezoars: A successful combined therapy. Gastrointest Endos. 2002;55(4):581-3. DOI: https://doi.org/10.1067/mge.2002.122332

Gallagher KC, Pinzon-Guzman C, Pierce RA, Tan MCB. Small Bowel Obstruction Caused by Bezoar Formation Around Intraluminal Hernia Mesh. Am Surg TM. 2022;88(8):1904-6. DOI: https://doi.org/10.1177/00031348221086788