CureusMassive Fecaloma Dissolved by Coca-Cola: A Case Report

⚠️ Small Study / Early Comparative Evidence
Authors documented an 82-year-old woman with dementia, type 2 diabetes, and reduced mobility who presented with a 12.2 cm sigmoid and rectal fecaloma unresponsive to polyethylene glycol, senna, mineral oil, and sodium phosphate enemas. Two 1000 mL Classic Coca-Cola enemas produced 50% size reduction after the first administration and full symptom resolution.

Clinical Considerations

• Conservative management failed over 12 hospital days; first Coca-Cola enema achieved 50% fecaloma reduction within 24 hours on repeat CT
• Mechanism attributed to acidity (pH ~2.5), sodium bicarbonate content, and CO₂ release extrapolated from phytobezoar dissolution
• Published literature includes fewer than a dozen case reports, all uncontrolled and anecdotal, with no standardized protocols
• Theoretical concerns include mucosal injury, electrolyte disturbance, and systemic caffeine absorption, though none reported in existing cases

Practice Applications

• Consider Coca-Cola enema as adjunctive option for refractory fecaloma before endoscopic or surgical escalation
• Recognize the evidence base as anecdotal and hypothesis-generating, not standard of care
• Monitor electrolytes, hemodynamics, and abdominal status during and after administration
• Avoid routine clinical adoption absent prospective data on safety, dosing, and dwell time

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