小腸糞石嵌塞病人使用可口可樂治療：一位個案研究

糞石嵌塞難以消化的物質在腸胃道停留過久所造成，發生小腸糞石時，易引起腸阻塞，病人會出現噁心、嘔吐、腹脹等不適症狀。本文描述一位62歲男性糖尿病病人，因下腹部持續鈍痛二天，伴隨噁心、嘔吐的情形，至某醫院急診求治，確診為：小腸糞石嵌塞（Small bowel ileus with bezoar），經給予口服可樂搭配藥物服用後，順利排出糞石之個案報告。病人之糞石阻塞的位置在小腸，無法使用胃鏡作治療，如果無法自行排出則需外科手術取出，但外科手術必定需要較長的恢復期，又糖尿病患者也是術後照顧的高危險群，故初步治療計劃是保持內科的支持性療法為優先選擇外加每日使用低卡可口可樂600cc的支持性療法。病人經由每日服用可樂600cc./day，於第三天病人開始排便、腹痛也明顯緩減，經小腸鋇劑攝影檢查確認已經沒有糞石嵌塞的情形，推論糞石已順利排出。

關鍵字

下腹部痛；腸阻塞；糞石；可樂

並列摘要

Bezoar is an uncommon clinical gastrointestinal problem, which is mostly caused by indigestible food debris that overstays in the gastrointestinal system. When the gastrointestinal tract is obstructed by bezoars, the patient will experience nausea, vomiting and abdominal distension. We reported a 62-yearold man with diabetes mellitus presenting to emergency room with lower abdomen dull pain for two days and accompanied by nausea and vomiting. He was diagnosed as small bowel ileus with bezoars impaction from series image studies. The bezoars were smoothly passed out after Coke and prokinetic agents were given. When bezoar is blocking the small intestine, it can not be retrieved by therapeutic endoscopy. Surgical intervention is recommended, and it certainly requires a longer recovery period of postoperative care especially in the patient with diabetes. The initial treatment plan is to maintain internal medical supportive therapy, such as: fasting, a lot of fluids, soft stools and prokinetic drugs. Additional daily use of low-calorie Coke 600cc supportive therapy was also applied. The patient was treated with 600cc of Coca-Cola per day and supportive care. After two days of the treatment he restored bowel movement and abdominal pain was significantly relieved. As well, the following up small bowel series confirmed disappearance of bezoars. The experience of this patient could be provided as a reference for clinical application.

並列關鍵字

lower abdominal pain ； intestinal obstruction ； bezoar ； Coca-Cola

參考文獻

Chen, H. W., & Chu, H. C. (2011). Migration of gastric bezoars leading to secondary ileus. Internal Medicine, 50(18), 1993-1995. doi:10.2169/internalmedicine.50.5637

Chung, Y. W., Han, D. S., Park, Y. K., Son, B. K., Paik, C. H., Jeon, Y. C., & Sohn, J. H. (2006). Huge gastric diospyrobezoars successfully treated by oral intake and endoscopic injection of Coca-Cola. Digestive and Liver Disease, 38(7), 515-517. doi:10.1016/j.dld.2005.10.024

Ertugrul, G., Coskun, M., Sevinc, M., Ertugrul, F., & Toydemir, T. (2012). Treatment of gastric phytobezoars with Coca-Cola given via oral route: A case report. International Journal of General Medicine, 5, 157-161. doi:10.2147/IJGM.S29453

Hayashi, K., Ohara, H., Naitoh, I., Okumura, F., Andoh, T., Itoh, T., ... Joh, T. (2008). Persimmon bezoar successfully treated by oral intake of Coca-Cola: A case report. Cases Journal, 1(1), 385. doi:10.1186/1757-1626-1-385

Ladas, S. D., Kamberoglou, D., Karamanolis, G., Vlachogiannakos, J., & Zouboulis-Vafiadis, I. (2013). Systematic review: Coca-Cola can effectively dissolve gastric phytobezoars as a first-line treatment. Alimentary Pharmacology & Therapeutics, 37(2), 169-173. doi:10.1111/apt.12141

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小腸糞石嵌塞病人使用可口可樂治療：一位個案研究

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