GASTROLITH-INDUCED SMALL BOWEL OBSTRUCTION TREATED USING COLA LYSIS THERAPY AND ENDOSCOPIC CRUSHING: A CASE REPORT

Abstract

A 69-year-old woman presented to our hospital for evaluation of abdominal pain and vomiting. CT revealed four air-containing gastric masses and one jejunal mass measuring up to 37 mm in size. The jejunal mass occupied the lumen, and the oral gastrointestinal tract was dilated and filled with intestinal fluid. Considering the patientʼs history of persimmon consumption, we suspected that the mass was a persimmon gastrolith, and the gastric stone had likely passed into the jejunum. We did not detect any evidence of peritoneal irritation; therefore, the patient received conservative treatment. We performed cola lysis therapy following ileus tube insertion and decompression. The gastrolith passed into the ileum and was eventually incarcerated in the ileum. We inserted a single balloon endoscope by the transanal route, injected cola and successfully used a snare to crush and remove the stone. Stone analysis revealed 98% tannin, which was consistent with the clinical suspicion of a persimmon gastrolith.