Abstract
BACKGROUND Phytobezoar-induced small bowel obstruction presents significant management challenges, particularly in patients who either decline surgery or have contraindications. These concretions, predominantly composed of persimmon tannins, account for 0.4-4.8% of intestinal obstructions in endemic regions. While surgical intervention remains standard for complete obstructions, non-surgical approaches are increasingly explored for high-risk patients. Current dissolution therapies, including the Coca-Cola protocol, often require large fluid volumes that can exacerbate the obstruction. This study evaluated the efficacy of a novel treatment using low-volume sodium bicarbonate irrigation combined with catheter decompression. CASE REPORT Two elderly men (aged 73 and 74 years) with persimmon-induced obstructions refractory to conservative treatment underwent endoscopic intestinal catheter placement. Targeted 5% sodium bicarbonate irrigation (100 mL bid) with intermittent catheter clamping was administered. Clinical progress was monitored through serial imaging and symptom assessment. Both cases achieved complete obstruction resolution without surgery. Case 1 demonstrated CT-confirmed bezoar reduction within 10 days, with spontaneous passage. Case 2 expelled a 3×7 cm bezoar after 5 days of therapy. No procedural complications or biochemical imbalances occurred. The protocol synergized bicarbonate's mucolytic action (alkaline dissolution of phytobezoar matrices) with mechanical catheter decompression. CONCLUSIONS This first-reported combination therapy successfully resolved large phytobezoars (4-7 cm) within 5-10 days, establishing a safe alternative for candidates who either decline surgery or have contraindications. The method's efficacy stems from: 1) minimized fluid volume requirements (200 mL/day vs 500-3000 mL in Coca-Cola protocols), 2) direct bezoar contact via catheter-directed delivery, and 3) dual mechanical-chemical action.