Trichobezoar effectively treated with direct endoscopic injection of Coca-Cola: A case report

Trichobezoars (hair bezoars) are primarily observed in adolescent girls who pull their hair followed by its ingestion. Endoscopic removal of trichobezoars is challenging, and these masses often require surgical removal. Recently, although it has been reported that Coca-Cola could effectively dissolve persimmon phytobezoars, it was ineffective in dissolving trichobezoars. We report a case in which Coca-Cola was directly injected into a trichobezoar followed by successful endoscopic removal of the mass. A 9-year-old girl visited our hospital with abdominal pain and nausea, wherein abdominal radiography revealed a mass in the stomach. Her mother witnessed her pulling and ingesting her hair 6 months previously. An upper endoscopy was performed for diagnosis of the trichobezoar. Endoscopic removal of the mass was performed under general anesthesia following oral administration of Coca-Cola at a dose of 100 mL thrice a day for 10 days. Initially, we attempted endoscopic extraction using grasping forceps and a radiofrequency snare. However, the bezoar could not be fragmented and did not pass through the cardia. Thus, Coca-Cola was injected directly into the bezoar using a local injection needle, which facilitated the separation of the bezoar and allowed the grasping forceps to fragment it to a size that could pass through the cardia. Owing to the large size of the bezoar, we could remove 180 g of it without complications. The patient received psychological counseling after the procedure, to prevent recurrence. In conclusion, direct injection of Coca-Cola was effective in the complete endoscopic removal of trichobezoars.