A Case of Fecal Intestinal Obstruction in Which the Enterolith Was Removed by Cola Dissolution Therapy and Endoscopic Lithotripsy

Abstract

The patient was a 79-year-old woman who presented to our hospital with a 3-day history of pain in the lower left abdomen. Physical examination revealed distension of the abdomen , and tenderness as well as rebound tenderness in the left flank and lower abdomen. Abdominal CT scan revealed the enterolith measuring approximately 52×43mm in the transverse colon. Furthermore, fecal mass retention was observed from the ascending colon to the transverse colon, with dilatation of the bowel. Based on the findings, we made the diagnosis of fecal intestinal obstruction. We admitted the patient to the hospital as an emergency and inserted a transanal bowel decompression tube. Neither the patient nor her family were willing for surgery as a treatment option, instead providing consent for cola dissolution therapy and endoscopic lithotripsy to remove the enterolith. Cola-dissolving therapy for an enterolith is thought to involve digestion of the fibrous tissue in the enterolith by acid in the cola and the mucolytic effect of sodium bicarbonate. We softened the enterolith by cola dissolution therapy; then, using a modified technique, we crushed it using a pair of grasping forceps under endoscopic guidance and flushed the contents through the anus. As compared with surgery, cola dissolution therapy and endoscopic lithotripsy are less burdensome to the patient and could be considered as valid treatment options in selected cases.