Successful treatment for a gastric persimmon bezoar in a pony using nasogastric lavage with a carbonated cola soft drink

Abstract

Gastric impactions in horses are usually caused by the ingestion of foreign materials, coarse roughage or feed that may swell after ingestion (Sanchez 2004). Poor dentition, chronic hepatic disease and inadequate consumption of water are identified as predisposing factors (Murray 2002). Clinical signs of gastric impaction range from anorexia and weight loss to severe abdominal pain. Recommended treatment involves repeated gastric lavage via nasogastric intubation or fragmentation of the impaction via laparotomy (Barclay et al. 1982; Honnas and Schumacher 1985; Owen et al. 1987). Ingestion of persimmons by horses can produce signs of abdominal pain by causing gastric impaction and gastric ulceration that may lead to perforation. Small intestinal obstruction with persimmons in horses has also been previously reported (Honnas and Schumacher 1985; Morgan 1994; Cummings et al. 1997; Kellam et al. 2000). Persimmon bezoars are often not discovered until a post mortem examination is performed. Laparotomy has been recommended for treatment of persimmon gastric impactions in horses (Honnas and Schumacher 1985; Kellam et al. 2000). Oral administration of a carbonated cola soft drink (Diet Coca-Cola)1 for resolution of persimmon impactions was first described in 3 human patients in Greece (Ladas et al. 2002), and was followed by multiple case reports of successful treatments (Kato et al. 2003; Sechopoulos et al. 2004; Martinez de Juan et al. 2006). For treatment of persimmon impactions, a large volume (3 l) of Diet Coca-Cola was administered through a feeding tube as a constant rate infusion. This resulted in the complete dissolution of the bezoars after 12 h of infusion. The patients were also recommended to drink Diet Coca-Cola as a prelude to further treatment. Other recommended treatments include the injection, via endoscopy, of Diet Coca-Cola directly into the bezoar (Chung et al. 2006). In this report we describe the successful medical treatment of one horse with gastric impaction caused by persimmons. To the authors¿ knowledge, no successful medical treatment for horses with gastric persimmon impactions has been previously reported. This report describes the treatment of a horse with a persimmon gastric impaction by administering a carbonated cola soft drink (Diet Coca-Cola) through a nasogastric tube.