Coca-Cola^® dissolution therapy for a bezoar impacted in the second portion of the duodenum: a case report

A bezoar is an insoluble mass formed in the stomach due to the degeneration of food or foreign substances by gastric juice and mucus. Tannin-rich persimmons are known to form bezoars, which can frequently cause gastric ulcers and intestinal obstructions. We report a case in which a bezoar impacting the second portion of the duodenum was successfully moved to the jejunum using Coca-Cola dissolution therapy, thus avoiding extensive surgical procedures such as pancreaticoduodenectomy.

A 76-year-old man presented at our hospital with vomiting. CT revealed a bezoar and intestinal obstruction in the second portion of the duodenum. Upper gastrointestinal endoscopy confirmed bezoar-induced obstruction. A conservative treatment with nasogastric decompression and Coca-Cola infusion was initiated. Although the first course was ineffective, repeated administration eventually moved the bezoar distally, and laparoscopic partial jejunal resection was performed. The postoperative recovery was favorable.

Complete endoscopic dissolution or removal of bezoars is often challenging, and surgical intervention is required in cases of persistent impaction. Duodenal impaction, particularly in the second portion, may necessitate pancreaticoduodenectomy, a highly invasive procedure. In the present case, a repeated Coca-Cola dissolution therapy facilitated distal migration of the impacted bezoar, enabling a less invasive surgical approach and potentially reducing operative morbidity.

We report a rare case in which a bezoar impacted in the second portion of the duodenum was successfully managed with a repeated Coca-Cola dissolution therapy, resulting in distal migration to the jejunum and avoidance of pancreaticoduodenectomy. This case highlights the potential role of conservative dissolution therapy as a bridge strategy to reduce surgical invasiveness in carefully selected patients.