CT imaging played a central role in both diagnosing a massive fecaloma and tracking a patient's response to a Classic Coca-Cola enema to dissolve it, according to a case study published April 21 in Cureus.
The case adds to the "small body of literature available and supports Classic Coca-Cola enemas as a potential adjunct before endoscopy or surgery is required," wrote a team led by medical student Victoria Estevez of Lake Erie College of Osteopathic Medicine (LECOM) in Bradenton, FL.
"Advantages [to this treatment] include wide availability, low cost, and minimally invasive administration," the group noted.
Chronic constipation can cause fecal impaction, which is an acute accumulation of hardened stool that can then lead to the development of fecalomas -- masses of fecal material that can require surgical removal when conservative measures fail, the group explained. Fecaloma prevalence increases with age, from 3% in patients in their 30s to 16% in patients over 70. Risk factors include not only chronic constipation, but also neurological disorders, such as Parkinson’s disease and Chagas disease, and manifestations of these masses can include abdominal pain, distension, urinary retention, and even megacolon or bowel obstruction.
Management of fecalomas ranges from conservative measures such as oral and rectal laxatives, enemas, and manual disimpaction, to minimally invasive endoscopic treatments or surgery. But these traditional approaches aren't always effective, failing in almost a third of patients, Estevez and colleagues wrote.
Classic Coca-Cola acts as a mucolytic agent, a source of carbonic acid, and an effervescent solvent, according to the researchers. It has traditionally been used to dissolve solid, indigestible masses of plant fiber that accumulate in the stomach, and some research has suggested that it could also dissolve fecalomas. The colon and the stomach differ, however -- for example, the colon maintains a near-neutral pH, while the stomach does not, making the question of whether use of the cola for fecalomas is effective unclear.
The team reported results from a case that involved 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 via the rectum for several days prior to admission. A physical examination revealed middle and lower abdominal tenderness and distension; CT imaging of the abdomen and pelvis showed a fecaloma 12.2 cm × 10.5 cm in the woman's sigmoid colon and rectum. There was no evidence of perforation. Five days of conservative treatment (polyethylene glycol, senna, mineral oil, and sodium phosphate enemas) failed to dissolve the fecaloma or resolve the patient’s symptoms: a follow-up CT exam showed no change in the size of the fecaloma.
On hospital day 13, the woman received an enema of 1,000 mL of Classic Coca-Cola. The day after this treatment, another CT exam showed a 50% reduction in fecaloma size. The patient underwent another 1,000 mL Classic Coca-Cola enema on hospital day 16, which resulted in complete resolution of her symptoms as indicated on CT imaging. She was discharged on a maintenance bowel regimen.
Panel A demonstrates the significant fecal impaction on admission. Panel B indicates fecaloma persistence after conservative measures on hospital day 5. Panel C shows significant reduction in size of the fecaloma one day after administration of a classic Coca-Cola enema. The red arrows indicate stool burden over the hospital course.Cureus
The study does suggest a need for more research on adverse events that could be caused by this type of fecaloma treatment, such as mucosal injury, electrolyte disturbances, or systemic effects such as caffeine absorption.
"Further prospective studies are needed to better define the safety and effectiveness of Classic Coca-Cola enemas prior to recommending its widespread use," the researchers concluded.
Access the full case here.
