Indigestible Foreign Materials Research Articles

Parasitism and rumen impaction in a 5-month–old Yankasa ewe: A clinico-pathological report

We report concurrent acariosis, helminthosis and foreign body rumen impaction of multiple aetiologies in a 5-month-old Yankasa ewe from a multispecies flock on semiintensive management system. The clinical findings were tachycardia, hypothermia, bradypnea, diarrhoea, emaciation, lethargy, pale mucous membranes, and heavy tick infestation attached to the skin of the forelimb, hind limb, inguinal region, and the ears. Severe non-regenerative anaemia, marked neutrophilia and lymphocytopenia characterized the blood picture. The ewe was treated for endo and ectoparasites, along with fluid therapy. However, the ewe died in the course of treatment and the carcass was subsequently presented for necropsy. Gross findings included the presence of numerous ticks attached to the skin of the outer ears and interdigits, indigestible foreign materials in the rumen and numerous worms in the rumen, abomasum and the intestine. Laboratory analysis revealed that the ticks were Rhipicephalus sp. and Amblyomma sp. The rumen worms were identified as Paramphistomum sp., the worms from the abomasum were identified as Haemonchus contortus, and those of the intestine were identified as Moniezia expansa. Histopathologically, there was hypertrophy of the chief cells of the abomasum. There was a section of Haemonchus contortus surrounded by eosinophils within the mucosa of the abomasum. The villi of the intestine sloughed-off into the lumen. Based on the clinicopathological findings, the diagnoses of acariosis, helminthosis and foreign body rumen impaction were arrived at. The remaining animals in the herd were treated accordingly and the farmer was advised to ensure good farm management practices.

Study on prevalence of indigestible foreign bodies in rumen and reticulum of cattle slaughtered at Bedeno Woreda Municipal Abattoir, Eastern Ethiopia

From October 2020 to April 2021, a cross-sectional study was undertaken at Bedeno Woreda Municipal Abattoir in Eastern Ethiopia with the goal of identifying and characterizing the prevalence of cattle indigestible rumen and reticulum foreign body, as well as its risk variables. This study included 384 cattle that were chosen at random. Prior to postmortem examination, an ante mortem examination was used to characterize a specific animal. A total of 154 (40.1%) of the 384 cattle evaluated were found to have indigestible foreign materials in their rumen and reticulum. Female cattle (54.4 percent) had a substantially greater prevalence of foreign bodies (2 = 25.817, p 0.05) than male cattle (29.0 percent). In terms of breed, the prevalence of foreign bodies was higher in cross breed (56.2 percent) animals than in local breed animals (38.6 percent). Poor (71.2 percent) had substantially more foreign bodies collected (2 = 69.138, p 0.05) than medium (52.9) and good (52.9). Score for bodily condition (18). The results showed that age has a significant connection (2 = 40.626, p 0.05) among different age groups of animals for foreign bodies (21.4 percent in young, 40.8 percent in adults, and 70.3 percent in old). The rumen was shown to have a higher percentage of foreign bodies (78.0%) than the reticulum (10.1%), with the remaining percent present in both the rumen and the reticulum. Plastic (53.4%) was the most commonly found foreign material in the rumen, while metallic material (35.3%) was found in the reticulum. The findings of this study revealed that improper solid waste garbage disposal in habitats poses a considerable danger of animal and environmental damage. As a result, the responsible government and community should focus their efforts on preventing the problem from worsening.

Indigestible Foreign Materials Impaction of Small Ruminants In Gombe State, Nigeria

This study aimed to investigate the prevalence and type of indigestible foreign material impaction in small ruminants in Gombe State, Nigeria. Sampling was carried out between February 2019 and January 2020, systematic random sampling technique, ante-mortem examination of selected goats and sheep prior to slaughter at the major abattoirs in Gombe State. The sex, age and body condition score of each animal was observed and recorded accordingly. Post-mortem examination of the rumen and reticulum was performed and foreign materials recovered were removed from the abdominal cavity, identified and recorded. Out of 1730 small ruminants examined, 1167 (67.46%) were found to harbour various types of indigestible foreign materials in their rumen and reticulum. The prevalence was significantly (χ2 = 58.047, p < 0.0001) higher in goats (38.0%) compared to sheep (23.7%). Prevalence rates in respective LGA sampled from Gombe, Yamaltu Deba, Akko, Funakaye and Kwami LGAs was 13.6%, 12.9%, 12.1%, 11.8% and 11.4% respectively. The prevalence of indigestible foreign materials was found to be significantly (p< 0.0001; χ2 = 732.87; OR = 47.009) higher in adult (59.6%) compared to young (2.1%), significantly (p< 0.0001; χ2 = 637.61; OR = 31.145) higher in female (42.5%) compared to male (19.2%), higher in goats (χ2 = 177.03, p < 0.0001) and sheep (χ2 = 191.39, p < 0.0001) with poor body condition score compared to those with medium and good body condition Significantly higher proportions of indigestible foreign materials were recovered in the rumen of affected goats and sheep compared to their reticulum. Plastic was the most commonly encountered indigestible foreign materials in goats and in sheep, followed by seed/nuts, rope and cloth. Lack of adequate plastic waste disposal system, extensive management system and free grazing of livestock in urban area are among the predisposing factors to the high prevalence of indigestible foreign material in ruminants in the study area. It was therefore recommended that collaborative intervention schemes involving government’s agencies and livestock farmers are required to increase public awareness about how to properly dispose of domestic waste.

Characteristics of Indigestible Foreign Materials in Forestomach of Dairy Cows in Different Farm Types

Characteristics of Indigestible Foreign Materials in Forestomach of Dairy Cows in Different Farm Types

S3177 Combination of Chemical Dissolution and Endoscopic Removal as an Alternative to Surgical Removal of Huge Phytobezoar

Introduction: Bezoars are the collection of undigested or slowly digested materials in the gastrointestinal tract. The phytobezoars are the most common type. Phytobezoars develop rapidly and usually present with gastric outlet obstruction symptoms. Here in, we report a case of giant phytobezoar which responded to chemical dissolution with carbonated fluids (Coca-cola) and cellulase which was later removed by endoscopic procedure. Case Description/Methods: A 65-year-old elderly male with a past medical history of arthritis presented with epigastric pain and vomiting for two months without any significant weight loss. He was found to have cholelithiasis and Cholecystitis on previous admission for similar complaints, for which he underwent laparoscopic cholecystectomy 1 month back. Persistent epigastric pain made us think of other possibilities. On further questioning, he said that he has been ingesting some herbs for arthritis. Subsequently, the patient underwent upper Gastrointestinal endoscopy, which revealed a stony hard, mobile, large bezoar of 9.0 × 10.0 cm. Endoscopic extraction was not possible due to hard consistency and huge size. Chemical dissolution with enzyme cellulase supplements and coca-cola drinks were advised to the patient. Two sequential endoscopies with an interval of 20 days demonstrated the reduced size of the bezoar, and it was successfully removed with the help of a polypectomy snare in piecemeal fashion. The patient remained symptoms free after the removal of the bezoar. Discussion: Gastric bezoars are indigestible foreign material and present with reduced gastric motility. Bezoars may be asymptomatic, but can cause serious complications. Diagnosis is made by imaging or by direct endoscopic visualization. Small soft bezoars can pass the intestinal tract and can be managed medically by inhibiting the gastric acid secretion or neutralizing secreted acid by administering the proteolytic enzymes, cellulase, carbonated fluids given orally or by gastric lavage followed by endoscopic fragmentation. However, large hard bezoars need aggressive surgical management. We treated the giant phytobezoar with chemical dissolution followed by endoscopic removal in piecemeal fashion. This approach has prevented the patient from going through the complications of surgical approach. We recommend that the chemical dissolution can be tried even in giant bezoars before considering a surgical approach. Ours is the first case that demonstrated the response of giant phytobezoar to chemical dissolution.

An unusual large polythene bezoar in the rumen of a fallow deer (Dama dama)

Ingestion of indigestible foreign bodies in both domestic and wild ruminants are very common. Indigestible foreign materials can be ingested during free range grazing or under captivity in zoos or game parks. There are different types of bezoars in literature. The most common in animals are phytobezoars, trichobezoars, lactobezoars, phytotrichobezoars, lithobezoars or pharmacobezoars. This is a case study of an adult (4 years old), 40 kg body weight female Fallow Deer (Dama dama) which was reared with other four more Fallow Deer does at Riyadh Zoological Garden. The doe was found sluggish and weak. On presentation the veterinarian of the zoo noticed the anorexia, pale mucous membranes and dullness. There was Normocytic Normochromic anaemia, low RBCs and Haematocrit level, high neutrophil count and leucocytosis. The doe was subjected to medicinal and supportive therapy but she could not recover and found dead on very next day. On post-mortem examination, an unusual large polythene bezoar along with calcified stony mass recovered from the rumen. The results suggested that the rumen impaction in the Fallow Deer might be due scavenging on refused Plastic dumps in the premises left over by visitors to the zoo and that the blood biochemical alterations, alongside clinical signs, might be of some diagnostic assistance.

Removal of a Small Bowel Bezoar Causing Bowel Obstruction via Mechanical Compression after Metal Stent Placement

Small bowel obstructions (SBOs) that develop for various reasons often require prompt medical treatment. Migration of a gastric bezoar (indigestible foreign material that has accumulated in the stomach) is a rare cause of SBO. Treatment of a symptomatic SBO caused by a bezoar requires a multidisciplinary approach that considers the patient’s physical status and comorbidities and the bezoar volume, location, and pathology. Although surgery is the treatment of choice, endoscopic treatments such as fragmentation and retrieval may serve as alternatives. We present the first case of resolution of a large phytobezoar via mechanical compression after covered metal stent insertion, followed by stent retrieval, in a patient with a symptomatic SBO that persisted even after two sessions of push-endoscopic fragmentation.

An unusual case of phytobezoar-induced small bowel obstruction

Bezoars, and to lesser extent phytobezoars, are among the rare causes of small bowel obstruction. A bezoar generally describes retained concretions of indigestible foreign material that accumulate and conglomerate in the gastrointestinal tract, most commonly in the stomach. We present an unusual case of phytobezoar-induced sub-acute small bowel obstruction originating from unfamiliar plant material in a 74-year-old woman. The past history was insignificant regarding comorbidities other than depression. Presenting complaints were history of abdominal pain and vomiting. Imaging studies and physical examination suggested small bowel obstruction. The patient underwent exploratory laparotomy after 1 day of conservative treatment. We found a 4.5 cm obstructing phytobezoar intraoperatively. The undigested plant material caused the obstruction. Postoperatively, the plant was identified as Scorzonera papposa. The patient was discharged uneventfully. The elderly patients should avoid semi-cooked vegetables, plants of unknown origin and high-fibre diet.

1748 Blood Bezoar: A Rare Complication of Achalasia

INTRODUCTION: Bezoars are retained concretions of indigestible foreign material that accumulate and conglomerate in any part of the GI tract but rarely in the esophagus. Only a few patients with achalasia have been reported to develop esophageal bezoars. CASE DESCRIPTION/METHODS: 76-year-old-man with history of atrial fibrillation on anticoagulation and achalasia s/p Heller myotomy in 1990, endoscopic dilation in 2007 and botox injection in 2015 who presented due to hematemesis after an episode of food binge. An upper endoscopy was performed with evidence of a severely dilated esophagus and presence of a bulky, cylindrical, foreign body composed of digested food and coagulated blood resembling a large blood sausage. The foreign body was removed through upper esophageal sphincter in piecemeal with a polypectomy snare and roth net using an overtube for airway protection. Two endoscopic procedures were necessary to completely remove the huge cylindrical esophageal bezoar. DISCUSSION: Bezoars are retained concretions of indigestible foreign material that accumulate and conglomerate in any part of the GI tract but rarely in the esophagus. They may occur due to ingestion of undigestible material or in patients with impairment in the grinding mechanism and the interdigestive migrating motor complex. Achalasia is an uncommon disorder resulting from progressive degeneration of ganglion cells in the myenteric plexus in the esophageal wall, leading to failure of relaxation of the lower esophageal sphincter accompanied by a loss of peristalsis in the distal esophagus. Dysphagia for solids and liquids and regurgitation of undigested food are the most frequent symptoms, however patients may also present with chest pain, heartburn, and difficulty belching. Only a few patients with achalasia have been reported to develop esophageal bezoars. In such cases, patients may be asymptomatic for years, or present with symptoms like abdominal pain, nausea, vomiting or serious complications like outlet obstruction, perforation and hematemesis. Upper endoscopy is regarded as the mainstay modality for the diagnosis and treatment of esophageal bezoars. In difficult cases, step by step management with N-acetylcysteine and gastrografrin spraying has been reported. Surgery should be reserved for select patients with bezoars if chemical dissolution and endoscopic fragmentation cannot be performed or fail, as well as for patients with significant complications such as obstruction and severe bleeding.

Upper Gastrointestinal Manifestation of Bezoars and the Etiological Factors: A Literature Review.

A gastric bezoar is a compact mass of indigestible foreign materials that accumulate and consolidate in the stomach; however, it can be found in other sites of the gastrointestinal tract. The causative manner of this condition is complex and multifactorial. The main purpose of the review was to raise awareness among clinicians, particularly gastroenterologists, that patients with certain risk factors or comorbid conditions are predisposed to gastric bezoar formation. Early diagnosis and prompt intervention are crucial to avoid bezoar-induced complications. Upper gastrointestinal endoscopy is the standard diagnostic and therapeutic method for gastric bezoars. However, for large size bezoars, surgical intervention is needed.

Small Bowel Obstruction Due to Phytobezoars: Report of Four Cases and Literature Review

Bezoars are concretions of indigestible foreign materials that develop within the gastrointestinal (GI) tract. A variety of materials received orally may form these masses. According to their composition, bezoars are classified as phytobezoars, which are the most frequent, trichobezoars, pharmacobezoars, lactobezoars, and other more rare entities. They are formed most frequently in the stomach and they may trigger serious symptoms, including dysphagia, abdominal pain, hematemesis, and intestinal obstruction or perforation. Contrast-enhanced computerized tomography (CT), in conjunction with GI endoscopy, has contributed substantially to the prompt and accurate diagnosis of these masses. Endoscopy also offers reliable therapeutic options, either through chemical disintegration of the bezoars or mechanical fragmentation and removal. The more serious cases of intestinal bezoars are usually treated surgically, either laparoscopically or via traditional laparotomy. This series describes four cases of intestinal phytobezoars that caused small bowel obstruction, and, in one case perforation, and were all treated surgically. Current advances in the diagnosis and treatment of bezoars are discussed and compared with the well-established methods.

Pathophysiological and clinical aspects of the diagnosis and treatment of bezoars.

Bezoars are intraluminal conglomerates of indigestible foreign materials that accumulate in the gastrointestinal (GI) tract. They consist of vegetable or fruit fibers, hairs or other substances; accordingly, bezoars are classified as phytobezoars, trichobezoars, pharmacobezoars, etc. Although sometimes asymptomatic, bezoars may cause serious symptoms, such as abdominal discomfort or pain, dysphagia, hematemesis, or even life-threatening entities (GI bleeding, obstruction or perforation). Current technological applications have contributed to the diagnostic and therapeutic approach to these masses, mainly through endoscopic techniques able to diagnose, fragment and extract bezoars, as well as laparoscopic and other surgical modalities that may be used to treat serious complications. Although bezoars were described centuries ago and the term was officially introduced in the mid nineties by Quain, they are still a demanding pathological entity. Their pathophysiology, accurate and prompt diagnosis, as well as successful and minimally invasive treatment, remain under investigation and see continuous progress. Current advances in these challenging areas are discussed in this review, which attempts to present an in-depth study of bezoars along with the well-established modalities and techniques.

Diagnosis of Bezoar-induced small-bowel obstruction on sonography in emergency department

Bezoars are defined as indigestible foreign materials impacting in the gastrointestinal tract, which are classified according to what they are composed of. Small intestinal obstruction caused by bezoar impaction was a rare disease. However, it has become more and more recognized since gastrectomy with truncal vagotomy was introduced into the treatment of peptic ulcer disease. Computerized tomography (“CT”) is still the imaging modality of choice in preoperative diagnosis of small bowel obstruction caused by bezoars. Although ultrasound has less sensitivity and specificity in detecting bezoars as compared with CT, it still can reveal bezoars in 88% of patients. Some case reports have addressed the role of sonographic detection of small intestinal phytobezoar. Ultrasonography may be a more available and time saving tool when used as a “screening” modality at emergency department for patients with mild persistent nonspecific abdominal pain but without definite peritoneal signs, especially when presence of past history of gastrectomy with truncal vagotomy.

Large gastric wood bezoar: Anesthesia implications.

Sir, Bezoars are collections or concretions of indigestible foreign material that accumulate and coalesce in the gastrointestinal tract, most commonly in the stomach. Gastric bezoar formation occurs in patients with altered gastric physiology, impaired gastric emptying and other co-existing illness affecting gastrointestinal motility. It is also commonly seen in patients with psychiatric illnesses and history of pica. In the pediatric population, common types of bezoar seen are lactobezoars, phytobezoars, and trichobezoars.[1] We report the case of a 7-year-old child with a large gastric wood bezoar. A 7-year-old male child weighing 20 kg presented with a history of pica, mostly wooden scrapings since 2½ years, pain in abdomen and vomiting. Upper gastrointestinal (UGI) endoscopy revealed a large gastric bezoar. The patient underwent endoscopy twice during which general endotracheal anesthesia was given but the attempts to remove the bezoar piecemeal were unsuccessful. Five days following the third endoscopy, the patient developed constipation, abdominal tenderness and guarding, and was scheduled for a laparotomy. The biochemical investigations of the patient were normal, except for hemoglobin level of 92 g%. Preoperative optimization of fluid status was done. Rapid sequence induction (RSI) was done using 40 mg of propofol and 20 mg of rocuronium intravenously, and the patient was intubated using 5.5 mm ID cuffed endotracheal tube. A 24 G lumbar epidural catheter was inserted postinduction for analgesia. Gastric perforation was seen on laparotomy caused either by the bezoar itself or the attempted endoscopic removal. After extending the incision, a phytobezoar measuring 13 cm × 11 cm (200 g) was removed, and the gastric perforation was closed [Figure 1]. Anesthesia was reversed, and recovery was uneventful.Figure 1: Wood bezoarThe anesthesiologist must be aware of the perioperative complications of a large gastric bezoar. The complication rate of endoscopy is 0.1% for UGI procedures with cardiopulmonary events predominating (50%) which include dysrhythmias, hypoxemia from respiratory depression, and cardiac arrest. Bleeding, aspiration, and perforation are other complications.[2] There is a reported case of respiratory arrest due to airway obstruction following the endoscopic removal of trichobezoar.[2] Certain co-morbid conditions such as cystic fibrosis, diabetes mellitus, hypothyroidism, Guillain–Barre syndrome, and renal failure, etc., have been associated with an increased risk of bezoar formation.[3] Bezoars are also associated with failure to thrive and iron deficiency anemia. Patients with protracted obstructive symptoms and vomiting are likely to be hypovolemic and have electrolyte disturbances. Preprocedure resuscitation may be required. RSI is indicated as these patients are at high risk of aspiration.[4] In pediatric patients, the cricoid pressure given during RSI can distort the airway and interfere with smooth induction. Furthermore, there are more chances of hypoxemia in the period between induction and reestablishment of ventilation.[5] Hence, we avoided the “classic” RSI and used gentle pressure limited mask ventilation with 100% oxygen following induction. The close psychiatric follow-up is recommended to diminish the chances of recurrence.[1] Laparoscopic removal of gastric bezoar is associated with less postoperative morbidity and pain but is technically challenging.[3] Our patient had borderline hemoglobin with a picture of iron deficiency anemia with normal electrolytes. The risk of aspiration was present as the patient had developed obstructive symptoms. Due to the large size of bezoar and risk of aspiration, RSI was done. As the patient was clinically stable, propofol was used for induction, and epidural anesthesia was also given. The patient was referred for psychiatric evaluation postoperatively. To conclude, the anesthetic plan to manage a gastric bezoar should include complications associated with preoperative fluid and electrolyte imbalance, the need for RSI and intubation, and issues associated with the procedure or surgery itself. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Investigations of foreign bodies in the fore-stomach of cattle at Ngoma Slaughterhouse, Rwanda.

Ingestion of indigestible foreign bodies in cattle is a pathological condition of both economic and health importance. It is has mostly been reported in association with feed scarcity. The aim of this study was to investigate the occurrence and nature of indigestible foreign materials in abattoir fore-stomach specimens in Ngoma district, Rwanda. Each chamber was opened by incision, then given a thorough macroscopic examination by visual inspection and palpation for the presence of foreign materials. The results show that there is an overall occurrence of 17.4% foreign bodies in cattle. The highest occurrence (25.3%) was recorded in June (the driest month). Results further show that the majority of the foreign bodies were plastics (65.0%). More foreign bodies (29.5%) were found in older animals (5 years and above) than in younger and middle-aged animals (16.5 % and 6.0%, respectively). There was a higher prevalence of foreign bodies in female cattle (20.0%) than in males (15.7%). The presence of cassette tape, as observed in the study, has not been reported elsewhere. The high representation of plastics in animals (65.5%) in the light of a government plastic bag ban in supermarkets presents a major challenge to livestock production in Rwanda. What is disturbing is that it is not known if this problem is increasing or decreasing as there are no previous studies for comparison. However, the results will serve as a reference point for future studies to understand the true trend and true burden of plastic bags in livestock.

Prevalence of Indigestible Foreign Materials in Small Ruminants Slaughtered At the Kumasi Abattoir of Ghana

An active survey was conducted from March to May, 2015, at the Kumasi Abattoir Company limited (KACL) to determine the prevalence of indigestible foreign materials (IFM) in the fore stomach of slaughtered small ruminants. Small ruminants presented for slaughter were randomly selected, tagged and then identified by sex, species and their body condition scored. After slaughter the stomach was removed carefully from the abdominal cavity and the forestomach incised to examine their contents. The type of foreign bodies found was recorded accordingly. The prevalence of IFM in small ruminants slaughtered at the Kumasi abattoir was 14.88%. Plastics (72.6 %), rope (14.1%), metal wire (8.2%), nails (8.2%), needles and other sharp objects (3.75%) rags (2.2%), sand pebbles (1.5 %) and broken bottles (0.75%) were the IFM identified in the fore stomach of small ruminants. IFM were more prevalent in fat animals (17.88%), followed by thin animals (17.23%) and least in average conditioned animals (7.94%). Environmental pollution with plastics and other indigestible foreign materials could pose serious health problems for extensively reared small ruminants. Plastics used for packing food and other items should be properly disposed off and small ruminants be provided supplementary feeding.

Ingestion of indigestible foreign materials by free grazing ruminants in Amhara Region, Ethiopia

Ruminants slaughtered in Bahir-Dar, northern Ethiopia, were studied to estimate the prevalence and types of foreign bodies in the rumen and reticulum. Of the 400 cattle, 320 sheep, and 320 goats examined between November 2011 and May 2012, 41.8, 20.6 and 11.9%, respectively, contained one or more types of foreign bodies. The prevalence of foreign bodies was significantly (P < 0.05) higher (i) in cattle than in sheep and goats, (ii) in cattle in poor body condition than those in good condition, and (iii) in the rumen than in the reticulum. The most commonly encountered materials were plastics, which resulted from the widespread use of plastic bags and improper waste disposal. Other materials found were cloth, rope, metal, and leather. The study demonstrated that ruminants in the area are ingesting various types of indigestible foreign bodies, which can hamper their health and productivity. To avert the problem, collaborative intervention schemes need to be applied involving professionals, policy makers, livestock keepers, and environmental activists.

Gastric trichobezoar: Food for thought

A bezoar is an agglomeration of food or indigestible foreign material in the gastro-intestinal tract. It is an uncommon cause of abdominal symptomatology and can result in intestinal obstruction. This report is of an adolescent girl with a history of abdominal distension and trichophagia.

Gastric Phytobezoar Treated by Oral Intake and Endoscopic Injection of Coca-Cola

Bezoars are collections or concretions of indigestible foreign material that accumulate and coalesce in the gastrointestinal tract; they usually occur in patients who have undergone gastric surgery and have delayed gastric emptying. Treatment options include dissolution with enzymes, endoscopic fragmentation with removal or aspiration, and surgery. Recently, the efficacy of nasogastric lavage or endoscopic infusion of Coca-Cola for the dissolution of phytobezoar have been reported. We report a case of phytobezoar successfully treated by oral administration and endoscopic injection of Coca-Cola. A 62-year-old woman was referred to Yeungnam University Hospital for epigastric pain. Upper gastrointestinal endoscopy revealed one very large, dark-greenish, solid bezoar in the stomach with gastric ulcer and duodenal bulb deformity. We performed endoscopic injection of Coca-Cola into the bezoar. The patient was instructed to drink four liters of Coca-Cola per day. At endoscopy two days later, the phytobezoar was easily broken into pieces. At endoscopy on the day of admission, the phytobezoar was decreased in size and removed by endoscopic fragmentation with a polypectomy snare. At follow up endoscopy after 13 days, the bezoar was completely dissolved.