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- W2912337837 abstract "Introduction: Gastric phytobezoars may cause gastric outlet obstruction. A large gastric phytobezoar can occurs in the setting of gastric dysmotility. Most common causes are gastroparesis associated with Diabetes, neuromuscular disease such as Parkinson's, hypothyroidism, or even abdominal operations such as a vagotomy. Case Presentation: A 69 year old man with past medical history of controlled hypothyroidism, pre diabetes with HgA1C of 6.8, and history of perforated peptic ulcer disease, status post vagotomy over 40 years ago, presented to the Emergency room with epigastric pain that has been going on in the past few months. The abdominal pain acutely worsened and was associated with nausea and vomiting prior to presentation. Abdominal x-ray and CT of the abdomen showed distended stomach with fecalization within. Nuclear medicine gastric emptying study did not show any emptying at 90 minutes. Naso-Gastric lavage with normal saline, and later with Acetylcysteine did not dissolve the bezoar. Upper endoscopy was attempted twice to break and remove the bezoar with no success. Eventually, gastric lavage with 4000 ml of Coca-Cola administered via nasogastric tube over 12 hours completely dissolved the phytobezoar. Repeat endoscopy confirmed the phytobezoar dissolution.Figure: Gastric fecalization seen on CT imaging.Figure: Gastric fecalization visible on abdominal imaging.Figure: Gastric Phytobezoar seen on upper endoscopy.Discussion: Vagotomy causes denervation of the pylorus and the stomach and requires a pyloroplasty to prevent obstruction. In our patient, upper endoscopy revealed an open and patent pylorus, however patient likely had chronic gastroparesis secondary to his abdominal operation. Patients were treated with Coca-Cola nasogastric lavage which has low pH, mucolytic effect from high sodium bicarbonate content, and CO2 bubbles which enhance dissolution. Complete phytobezoar dissolution was achieved in one session without any complication, and was well tolerated. Coca-Cola lavage is a safe, rapid, cheap, and effective method. Patients may be treated in the medical ward, avoiding therapeutic endoscopy or surgery. Still, once bezoar is removed, emphasis must be placed upon prevention of recurrence." @default.
- W2912337837 created "2019-02-21" @default.
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- W2912337837 date "2017-10-01" @default.
- W2912337837 modified "2023-09-25" @default.
- W2912337837 title "Magic of Coca-Cola: A Case Presentation and Management of Gastric Outlet Obstruction Caused by Gastric Phytobezoar" @default.
- W2912337837 doi "https://doi.org/10.14309/00000434-201710001-02549" @default.
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