Coca-Cola® dissolution therapy for a bezoar impacted in the second portion of the duodenum: a case report

Introduction: A bezoar is an insoluble mass formed in the stomach due to the degeneration of food or foreign substances by gastric juice and mucus. Tannin-rich persimmons are known to form bezoars, which can frequently cause gastric ulcers and intestinal obstructions. We report a case in which a bezoar impacting the second portion of the duodenum was successfully moved to the jejunum using Coca-Cola dissolution therapy, thus avoiding extensive surgical procedures such as pancreaticoduodenectomy. Case presentation: A 76-year-old man presented at our hospital with vomiting. CT revealed a bezoar and intestinal obstruction in the second portion of the duodenum. Upper gastrointestinal endoscopy confirmed bezoar-induced obstruction. A conservative treatment with nasogastric decompression and Coca-Cola infusion was initiated. Although the first course was ineffective, repeated administration eventually moved the bezoar distally, and laparoscopic partial jejunal resection was performed. The postoperative recovery was favorable. Discussion: Complete endoscopic dissolution or removal of bezoars is often challenging, and surgical intervention is required in cases of persistent impaction. Duodenal impaction, particularly in the second portion, may necessitate pancreaticoduodenectomy, a highly invasive procedure. In the present case, a repeated Coca-Cola dissolution therapy facilitated distal migration of the impacted bezoar, enabling a less invasive surgical approach and potentially reducing operative morbidity. Conclusion: We report a rare case in which a bezoar impacted in the second portion of the duodenum was successfully managed with a repeated Coca-Cola dissolution therapy, resulting in distal migration to the jejunum and avoidance of pancreaticoduodenectomy. This case highlights the potential role of conservative dissolution therapy as a bridge strategy to reduce surgical invasiveness in carefully selected patients.