My name is Dr. Jesus Guzman and today we will be presenting our case on Fecalith Obstruction Result with Dr. Pepper. I have no disclosures to report. Today we present a 39 year old male with no significant past medical history that presented with prolonged abdominal pain and constipation with associated nausea and vomiting. Patient had failed to pass gas for approximately three days. Patient had attempted a high fiber diet and exercise regimen at home with no resolution of symptoms. On admission patient had a CT of the abdomen completed with contrast. It showed a diffuse distension of the colon to the level of the junction of the descending and sigmoid colon. There was an intraluminal mass proximal to the obstruction measuring 5 by 4 by 4.1 centimeters. Patient underwent evaluation via colonoscopy. Upon entering the distal descending colon we encountered a large approximately five centimeter obstructing fecalith. Attempts at breaking apart the fecalith with a stiff snare and raptor forceps were not fruitful. Therefore decision was made to inject the fecalith with a carbonated beverage. In this case we had Dr. Pepper available in our break room. Using a Olympus Needle Master the soda was injected directly into the center of the fecalith. After a few injections the combination of carbonation, acidity of the fluid and some mild force the fecalith was successfully softened and then broken into pieces. The scope was then able to be advanced to the right colon. The proximal colon was decompressed and the procedure was completed in less than 20 minutes. Patient was successfully discharged from the hospital with resolution of symptoms. Patient then returned for a follow-up colonoscopy which showed a normal appearing mucosa. In conclusion carbonated beverages can be used for the management of phytophysoras in the setting of an obstruction.

abdominal pain

constipation

colon obstruction

fecalith

carbonated beverage