2020 Volume 62 Issue 8 Pages 1474-1480
A 62-year-old female patient with a 5-year history of ulcerative colitis that affected the entire colon had been treated with 5-ASA and oral steroids in a hospital. She was treated with herbal medicine including indigo naturalis by her primary care doctor due to deterioration of the disease condition. She developed vomiting, diarrhea with bloody stool, and abdominal pain more than 3 weeks after starting indigo naturalis. She developed an intestinal obstruction of the small intestine, and was transferred to our hospital. Double-balloon endoscopy showed stenosis 50cm distal from the Treitz ligament. The length of the stenosis was 10cm with a shallow and sharply demarcated ulcer arranged in a circular manner. Partial resection of the small intestine was performed. In the surgical specimen, there were ulcers with a wide range of depths with stricture of the small intestine. The diagnosis of ischemic enteritis was confirmed. After surgery, she has been healthy without recurrence.
Indigo naturalis has been shown to be a promising therapeutic agent for ulcerative colitis, but various side effects including liver dysfunction, pulmonary arterial hypertension, and intussusception, have been reported. This is the first report of ischemic enteritis induced by indigo naturalis. Further studies are needed to elucidate the mechanism by which indigo naturalis causes small intestinal ischemia.
