Giant Rectal Fecaloma Treated with Carbonated Soft Drink and Argon Plasma Coagulation.

Abstract

Constipation is a common gastrointestinal disorder affecting approximately 15% of the population, with a higher prevalence in women and older adults. It can be classified as primary, including functional constipation, pelvic floor dysfunction, and slow transit, or secondary, resulting from neurological, endocrine, metabolic disorders, cancer, or medications. In individuals over 75, constipation ranks as the seventh most common condition in primary care. A severe complication, fecal impaction, occurs more frequently in older adults and accounts for 0.03% of emergency department visits, with the highest risk in those over 85. In Parkinson's disease, constipation is a significant nonmotor symptom affecting up to 63% of patients and may lead to complications such as intestinal obstruction and aspiration pneumonia. We present the case of a 94-year-old male with Parkinson's disease who developed a 5 × 5 cm rectal fecaloma, unresponsive to standard endoscopic fragmentation techniques, including retrieval tools, high-pressure water jets, and polypectomy snares. Carbonated soft drink (Coca-Cola^®) injection (500 ml) was used to soften the fecaloma, followed by off-label argon plasma coagulation (APC) (30-50W, 2 l/min), which successfully facilitated further fragmentation and near-total removal. This case highlights the potential role of Coca-Cola^® and APC as adjunctive therapies in managing refractory fecalomas.

Learning points: Standard fecaloma fragmentation methods failed necessitating the injection of a carbonated soft drink (Coca-Cola^®) into the lumen of the fecaloma and pouring its surface with it followed by the off-label use of argon plasma coagulation for full breakdown of the fecaloma.This highlights the importance of Coca-Cola^® and argon plasma coagulation as adjunctive therapies in managing refractory fecalomas, with further studies needed to propose the mechanism by which these tools can trigger fecalomas breakdown.