a small bowel phytobezoar in a child with down syndrome: partial response to ultrasound-guided coca-cola injection

This case report describes the management of an 18-month-old male infant with down syndrome who presented with small bowel obstruction secondary to a jejunal phytobezoar. the bezoar formed following the ingestion of a traditional home remedy consisting of mashed rice, lentils, and beets, compounded by psyllium powder administration. initially, the parents refused of surgical intervention, so ultrasound-guided direct injection of coca-cola was proposed as an alternative non-surgical therapy. after obtaining written informed consent, 50 ml of coca-cola was injected into the bezoar core under real-time ultrasound guidance. this intervention led to partial bezoar transformation and distal migration to the ileum within 12 hours. however, the bezoar ultimately lodged in the terminal ileum, necessitating definitive surgical removal. this case illustrates the challenges of managing small-bowel bezoars in high-risk pediatric patients and highlights both the potential and limitations of non-surgical dissolution techniques.