Coca-Cola Enema Resolves Massive Fecaloma, Avoids Surgery: Case Report
USA: A recent case report published in the Cureus Journal of Medical Science highlights an unconventional yet potentially effective approach to managing a large fecaloma, using a Coca-Cola enema. The report, authored by Victoria M. Estevez and colleagues from the Lake Erie College of Osteopathic Medicine, underscores the role of imaging in both diagnosis and monitoring treatment response in such cases.
Fecalomas are dense accumulations of hardened stool that can arise as a complication of long-standing constipation. These masses may lead to symptoms such as abdominal pain, distension, and, in severe cases, bowel obstruction or megacolon. Their occurrence becomes more common with advancing age and is often associated with underlying conditions such as neurological disorders, including Parkinson’s disease. Standard management strategies typically include laxatives, enemas, and manual disimpaction, while more resistant cases may require endoscopic intervention or surgery. However, these approaches are not universally successful, with failure reported in a notable proportion of patients.
In the reported case, an 82-year-old woman with multiple comorbidities—including Type 2 Diabetes, hypertension, hypothyroidism, and dementia—presented with acute abdominal discomfort and an absence of bowel movements for several days. Imaging with computed tomography revealed a large fecaloma measuring over 12 cm in the sigmoid colon and rectum. Importantly, no signs of perforation were observed.
Initial treatment involved a combination of standard therapies, including polyethylene glycol, stimulant laxatives, and enemas, administered over five days. Despite these efforts, follow-up imaging showed no reduction in the size of the fecal mass, and the patient’s symptoms persisted.
Given the lack of response, clinicians opted for an alternative approach using a Coca-Cola enema. On the 13th day of hospitalization, 1 liter of the beverage was administered rectally. Subsequent CT imaging demonstrated a substantial reduction—approximately 50%—in the size of the fecaloma. A second enema was given three days later, resulting in complete resolution of the mass and the patient’s symptoms. Restoration of bowel function allowed the patient to avoid surgical intervention, and she was discharged on a maintenance bowel regimen.
The authors suggest that Coca-Cola may act through multiple mechanisms, including its acidic pH, effervescent properties, and mucolytic effects, which may help break down hardened material. While the beverage has been previously used to dissolve gastric phytobezoars, its application in the colon remains less well established due to physiological differences between the stomach and large intestine.
Although the findings are promising, the authors caution that further research is needed to establish the safety and efficacy of this approach. Potential risks such as mucosal irritation, electrolyte imbalances, and systemic absorption of components like caffeine warrant careful evaluation.
The case contributes to a growing body of evidence supporting Coca-Cola enemas as a possible adjunctive therapy in refractory fecaloma cases, particularly when conventional treatments fail and before resorting to invasive procedures.
Reference:
Estevez V M, Javanshir S, Lane J, et al. (April 21, 2026) Massive Fecaloma Dissolved by Coca-Cola: A Case Report. Cureus 18(4): e107453. doi:10.7759/cureus.107453
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