Colonoscopic instillation of Coca Cola for treatment of fecal impaction

Abstract

Aim: To report experience with use of CO2 bubbles and acidic pH of coca cola for clearance of fecal impaction. Case Report: Thirty-seven year old male presented with constipation since childhood, discomfort and mass lower abdomen for 2 months and inability to pass stool for 1 month. There was no history of cessation of flatus, hematochezia, fever, weight loss or urinary symptoms. Examination revealed firm, pitting pelvic mass extending midway between symphisis pubis and umbilicus. AXR showed grossly dilated rectum and sigmoid colon full of fecal matter with no air-fluid levels. CECT abdomen showed no bowel thickening, ascites or lymphnode enlargement. Attempts at clearance of stool with sodium phosphate enema and manual evacuation were unsuccessful. Following informed consent, colonoscope (Olympus CF- H180AL) was introduced upto descending colon. Coca cola 3.6 litres was introduced through the colonoscope with 50 cc syringe from descending colon to rectum by gradual withdrawal. The patient was kept in left lateral, supine, right lateral and prone positions for 10 min each and then asked to evacuate in bed-side chair pan. Over the next hour he passed over 10 litres of fragmented and liquid stool. Repeat AXR showed complete evacuation of rectum and sigmoid colon with transition zone close to internal anal sphincter suggestive of ultra-short segment adult Hirschprung's disease. There was no complication. The patient refused rectal manometry and full thickness rectal biopsy. Conclusion: Colonoscopic instillation of coca cola is effective for treatment of fecal impaction refractory to conventional measures.