Cola Dissolution Therapy via Ileus Tube Was Effective for Ileus Secondary to Small Bowel Obstruction Induced by an Enterolith

Abstract

An 87-year-old bedridden woman developed intestinal obstruction caused by an enterolith or bezoar. Since the patient refused surgery, we administered 1,000 mL/day of cola via an ileus tube to dissolve the stone. Occlusion of the small intestine disappeared on day 6. The excreted stones contained calcium phosphate, which is typical of enteroliths. We later confirmed that the retrieved stones could be dissolved in cola (Coca-Cola^®, pH 1.9) as well as 0.10 and 0.010 mol/L hydrochloric acid (pH 1.0 and 2.0, respectively) and food-grade vinegar (pH 2.6). These findings suggest that the enteroliths were dissolved by an acid-base reaction.

Keywords: acid-base reaction; cola; enterolith; intestinal obstruction.

Figure 1.

Abdominal plain computed tomography (CT) findings at the previous hospital (A) and enhanced CT findings on admission (B). CT detected a shadow in the small intestine, appearing as a high-intensity area (arrowhead). B shows that this area had moved to the anal side of the intestine on admission.

Figure 2.

Abdominal ultrasonography findings on admission. A moveable substance with an acoustic shadow was detected in the small intestine.

Figure 3.

Small intestine enema after ileus tube insertion. (A) Full abdominal image during the small bowel series. There was no diverticulum in the patient’s small intestine. (B) Magnified image of the arrowhead in (A). A large substance (arrowheads) had become stuck in the small intestine.

Figure 4.

X-ray findings on Day 2 (A) and Day 6 (B) after starting cola injection and collecting the stones (C). The substance in the small intestine shrank on Day 2 and had disappeared by Day 6. Dispersed stones were excreted in the stool. The arrowhead shows the substance in the small intestine.

Figure 5.

A calculus before and after being placed in 20 mL of purified water [before (A), after (D)], carbonated water [before (B), after (E)], and Coca-Cola^® [before (C), after (F)]. The calculus became lighter in Coca-Cola^®, but its weight did not change in purified water or carbonated water.