Colonoscopic Instillation of Coca-Cola for Evacuation of Large Fecaloma: A Report of Two Cases and Review of Literature

Introduction Fecaloma is a large mass of organized hardened feces causing impaction, usually in rectum and sigmoid colon. Medical management usually entails digital evacuation, use of clearance enema, and oral laxatives. We report two patients managed successfully with colonoscopic instillation of Coca-Cola and review the literature. Case Report Patient 1: A 37-year-old male presented with firm, nontender, pitting mass over lower abdomen for 2 months and inability to pass stool for 1 month. Per-rectal examination and imaging confirmed presence of solid stool with gross distension of rectum and sigmoid colon. Attempts at clearance of stool with conventional methods were unsuccessful. At colonoscopy, 4 L of Coca-Cola was instilled into descending and sigmoid colon, leading to evacuation of 10 L of fragmented and liquid stool.Patient 2: A 72-year-old diabetic lady presented with constipation and tender, firm pelvic mass extending till mid-abdomen for 6 months. Per-rectal examination revealed presence of hard stool. Imaging confirmed large amount of fecal matter in dilated rectum, sigmoid, and descending colon. Attempts at evacuating stool with digital evacuation, sodium phosphate enema, and oral polyethylene glycol were unsuccessful. At colonoscopy, two sittings of instillation of 990 mL of Coca-Cola Light each were done into sigmoid colon over 2 days, resulting in clearance. Conclusion Colonoscopic instillation of Coca-Cola may be effective in evacuation of large fecaloma from rectum, sigmoid, and descending colon when refractory to use of conventional methods like digital disimpaction, rectal enema, and oral laxatives.

Colonoscopy and flexible sigmoidoscopy

Colonoscopy involves full oral bowel preparation and planned examination of the whole large bowel, while flexible sigmoidoscopy is usually performed after a phosphate enema and visualizes only the rectum and left colon. In expert hands, after appropriate explanation to the patient (which increases the chances of the procedure being well tolerated), and (usually) some form of ‘conscious sedation’, total colonoscopy is possible in 98 to 99% of cases in the absence of obstruction, a severely ulcerated colon, or other contraindication. The indications for colonoscopy are wide and constantly expanding, and are likely to continue to do so until alternative less invasive techniques (‘virtual colonoscopy’ or genetic tests) are perfected. Common indications include patients with or requiring (1) bleeding, anaemia, or occult blood loss; (2) chronic diarrhoea or known inflammatory bowel disease, which is accurately and easily assessed by endoscopy and biopsy; (3) polyps that can be removed endoscopically; and (4) surveillance for cancer prevention. Therapeutic colonoscopy now allows resection of almost all benign colonic polyps and some very early cancers as well as dilatation of anastomotic or Crohn’s disease strictures and stenting of malignant strictures.

Phosphate Enema Causing Life-Threatening Rectal Perforation

We report a near fatal rectal perforation due to a phosphate enema in an elderly male. The presentation in septic shock within 4 hours of the enema is quite rare. Early recognition and prompt management are essential for a good outcome. A defunctioning colostomy is standard for these cases but we recommend a distal rectal washout since intraluminal faeces in a loaded rectum could be a cause of ongoing sepsis. Although enemas are commonly used for constipation in the elderly, suppositories and oral preparations should be used preferentially where appropriate.

Perbandingan Tatalaksana Konstipasi Kronis antara Disimpaksi per Oral dengan per Rektal di Instalasi Kesehatan Anak RS DR Sardjito Yogyakarta

Latar belakang. Konstipasi adalah kelainan yang sering terjadi dan menimbulkan masalah yang serius padabayi dan anak. Penyebab konstipasi dapat dibagi menjadi penyebab non organik/fungsional dan penyebaborganik. Tatalaksana anak dengan konstipasi fungsional meliputi beberapa langkah, 1) edukasi, 2) pengeluaranfeses/disimpaksi, 3) fase pemeliharaan. Pada disimpaksi dan fase pemeliharaan diperlukan laksansia secara oralataupun rektal.Tujuan. Membandingkan disimpaksi oral (Laktulose) dengan per rektal (phosphate enema) pada anakdengan konstipasi kronis, kedua obat ini dari golongan yang sama yaitu laksansia osmotikMetode. Merupakan penelitian uji klinis acak terkendali. Sampel penelitian adalah anak konstipasi fungsional yangberobat jalan dan dirawat di Instalasi Kesehatan Anak RS Dr. Sardjito Yogyakarta dan memenuhi kriteria inklusidan kriteria eksklusi, usia antara 􀁴6 bulan – 14 tahun akan dilakukan uji disimpaksi per oral atau per rektal.Hasil. Angka kesembuhan pada kelompok terapi per oral lebih sedikit dibanding per rektal (=0,636, IK95% 0, 336-1,205), p=0,162. Efek samping yang timbul yaitu kembung (RR=0,857, IK 95% 0,633-1,160),p=0,285, nyeri perut (RR=0,583, IK 95% 0,141-2,410), p=0,312, diare (RR=0,952, IK 95% 0,611-1,484),p=0,832. Penerimaan terhadap obat yang diberikan pada anak (RR=1,000, IK 95% 0,699-1,448), p=1,000,pada orang tua (RR=1,1670, IK 95% 0,862-1,579), p=0,317. Perubahan gejala konstipasi setelah intervensiobat, yaitu retensi (RR=1,40, IK 95% 0,112-17,543), p=0,802, soiling (RR=1,40, IK 95% 0,875-2,237),p=0,171, konsistensi feses (RR=1,20, IK 95% 0,839 -1,716), p=0,071.Kesimpulan. Tidak terdapat perbedaan efektifitas pada kedua kelompok, hanya dalam lama terapi lebihcepat pada laksansia per rektal dibandingkan per oral. Tidak terdapat perbedaan yang bermakna pada keduakelompok dalam mengurangi retensi, nyeri saat defekasi dan konsistensi feses. Tidak ditemukan efek sampingyang bermakna pada pemakaian laksansia per oral ini. Laksansia per oral lebih mudah diberikan dibandinglaksansia per rektal walau hasil tidak berbeda bermakna.