Korean J Gastroenterol.  2015 Jul;66(1):46-49. 10.4166/kjg.2015.66.1.46.

Successful Removal of Hard Sigmoid Fecaloma Using Endoscopic Cola Injection

• Lee JJ
• Kim JW

• KMID: 2373311
• DOI: http://doi.org/10.4166/kjg.2015.66.1.46

Abstract

Colorectal fecaloma is hardening of feces into lumps of varying size that is much harder in consistency than a fecal impaction. Complications of colorectal fecaloma include ulceration, bleeding, perforation and obstruction of the colon. Most fecalomas are successfully removed by conservative treatment with laxatives, enemas and rectal evacuation to relieve fecal impaction. When conservative treatments have failed, a surgical intervention may be needed. Herein, we report a case of 4.7 cm sized sigmoid fecaloma showing no response to conservative treatments that was successfully removed by endoscopic fragmentation with Coca-Cola injection instead of surgery.

Keyword

Fecal impaction; Sigmoid colon; Cola; Endoscopy

MeSH Terms

Adult
Cola/*chemistry
Colon, Sigmoid
Colonoscopy
Fecal Impaction/*drug therapy
Female
Humans
Laxatives/*therapeutic use
Radiography, Abdominal
Tomography, X-Ray Computed
Laxatives

Figure

• 

  Fig. 1. Erect simple abdomen (A) and supine simple abdomen (B) demonstrate accumulation of bowel gas in the sigmoid colon (arrows).

• 

  Fig. 2. Colonoscopy shows a huge hard round-shaped fecaloma in the sigmoid colon.

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  Fig. 3. Abdominopelvic CT reveals a 4.7 cm sized fecaloma in the distal sigmoid colon (arrows).

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  Fig. 4. Endoscopic findings. (A) Coca-Cola is injected to the fecaloma using injector. (B) Fecaloma is broken into smaller pieces using a snare.(C) The fecaloma is finally fragmented.

Reference

References

1. Aiyappan SK, Ranga U, Samraj A, Rajan SC, Veeraiyan S. A case of fecaloma. Indian J Surg. 2013; 75:323–324.

2. Kim KH, Kim YS, Seo GS, Choi CS, Choi SC. A case of fecaloma resulting in the rectosigmoid megacolon. Korean J Neurogastroenterol Motil. 2007; 13:81–85.

3. Yoon SS, Kim MS, Kang DY, et al. A case of successful colonoscopic treatment of colonic obstruction caused by phytobezoar. J Korean Soc Coloproctol. 2011; 27:211–214.

4. Deepak P, Ehrenpreis ED. Other effects on the colon. Dis Mon. 2011; 57:518–523.

5. Manne JR, Rangu VM, Motapothula UM, Hall MC. A crunching colon: rectal bezoar caused by pumpkin seed consumption. Clin Med Res. 2012; 10:75–77.

6. Kim SM, Ryu KH, Kim YS, et al. Cecal fecaloma due to intestinal tuberculosis: endoscopic treatment. Clin Endosc. 2012; 45:174–176.

7. Kang JH, Lim YJ. Can fecaloma be dissolved by cola injection in a similar way to bezoars? Intest Res. 2014; 12:333–334.

8. Shin HY, Kim MJ, Song EH, et al. A case of a huge gastric bezoar treated with an endoscopic Coca-cola injection and an Argon plasma beam. Korean J Med. 2010; 79:48–52.