Massive Fecaloma Dissolved by Coca-Cola: A Case Report

Fecalomas are hardened masses of fecal material that are a rare complication of chronic constipation and require surgical resection when conservative measures fail. Recent reports suggest that Coca-Cola, traditionally used to dissolve gastric phytobezoars, may also aid in the dissolution of fecalomas. We report the case of an 82-year-old woman with dementia, type 2 diabetes, hypertension, hypothyroidism, chronic gastritis, and depression who presented with acute abdominal pain. She had not produced stool or passed gas per rectum for several days prior to admission. Physical examination revealed middle and lower abdominal tenderness and distension. Computed tomography (CT) scan of the abdomen and pelvis demonstrated a large fecaloma (maximum diameter 12.2 cm) in the sigmoid colon and rectum, without evidence of perforation. Conservative management, including polyethylene glycol, senna, mineral oil, and sodium phosphate enemas, failed to resolve the fecaloma or the patient's symptoms. Two 1 L Classic Coca-Cola enemas were then administered, resulting in a significant reduction in the size of the fecaloma on imaging and complete resolution of symptoms. With the return of bowel function, the patient avoided surgery and was able to be discharged on a maintenance bowel regimen. This case contributes to the increasing number of reports supporting Classic Coca-Cola as an adjunct to conservative therapies for fecalomas that are refractory to conservative management.