Severe Airway Obstruction Caused by Esophageal Bezoar with Coca-Cola and Creon (Pancrelipase) in a Patient with Underlying Achalasia: A Comprehensive Case Report.

Autor: Urlapu KS; Division of Pulmonary and Critical Care Department of Medicine Bronx Care Health System Affiliated with Icahn School of Medicine at Mount Sinai, New York, Bronx, USA., Mantri N; Division of Gastroenterology Department of Medicine Bronx Care Health System Affiliated with Icahn School of Medicine at Mount Sinai, New York, Bronx, USA., Patel H; Division of Gastroenterology Department of Medicine Bronx Care Health System Affiliated with Icahn School of Medicine at Mount Sinai, New York, Bronx, USA., Lajara Hallal P; Department of Medicine Bronx Care Health System Affiliated with Icahn School of Medicine at Mount Sinai, New York, Bronx, USA., Chilimuri S; Division of Gastroenterology Department of Medicine Bronx Care Health System Affiliated with Icahn School of Medicine at Mount Sinai, New York, Bronx, USA., Diaz-Fuentes G; Division of Pulmonary and Critical Care Department of Medicine Bronx Care Health System Affiliated with Icahn School of Medicine at Mount Sinai, New York, Bronx, USA.
Jazyk: angličtina
Zdroj: Case reports in gastrointestinal medicine [Case Rep Gastrointest Med] 2024 Jul 27; Vol. 2024, pp. 2081040. Date of Electronic Publication: 2024 Jul 27 (Print Publication: 2024).
DOI: 10.1155/2024/2081040
Abstrakt: Introduction: The occurrence of acute respiratory failure as a result of esophageal bezoars is a rare phenomenon. We present a patient who failed initial endoscopic intervention. Successful resolution was achieved through a novel approach involving a combination of Creon and Coca-Cola. Subsequently, the patient was diagnosed with achalasia, a condition that potentially contributed to the formation of the esophageal bezoar. Case Description . An 82-year-old man presented with respiratory distress, necessitating endotracheal intubation for airway protection. A chest computed tomogram (CT) showed pneumonia and a distended esophagus compressing the trachea, raising the possibility of an esophageal food bolus. Endoscopy revealed a severely dilated esophagus containing a significant amount of food and a phytobezoar in the lower esophagus. He failed various endoscopic techniques to remove the obstruction. Given the patient's poor surgical candidacy, he was started in a thrice-daily regimen of Creon dissolved in 165 mL of Coca-Cola, over a 4-day period. A subsequent endoscopy revealed no discernible evidence of food or bezoar. The patient was weaned from mechanical ventilation. A high-resolution esophageal manometry identified type 1 achalasia.
Conclusion: Esophageal food impaction leading to respiratory failure is rare. Endoscopy remains the mainstay approach. Surgical interventions carry significant risks. This case emphasizes the potential for noninvasive management in patients with esophageal bezoars and also underscores the significance of contemplating esophageal pathologies when addressing cases of respiratory failure. The use of Coca-Cola and Creon emerges as a safe, effective, and cost-efficient treatment, providing a feasible option when endoscopy proves unsuccessful before considering more aggressive interventions.
Competing Interests: The authors declare that they have no conflicts of interest.
(Copyright © 2024 Kinnera Sahithi Urlapu et al.)
Databáze: MEDLINE
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