Abstract
A 20 year old female was admitted to our hospital complaining of tarry stool andsevere abdominal pain, several hours after she had taken two tablets of cathartics (sennoside A & B 12 mg/tablet). She had been well without constipation until half a day before admission. Colonoscopy and Ba enema examination were performed within a few days afteradmission and they showed severe colitis localized within the right side of colon. The mucous membrane of the rectum, sigma and colon descendens were comuletely intact. The views of endoscopic pictures and pathological findings of her biopsy specimens taken from the colon ascendens bore a close resemblance to those of fulminant ulcerative colitis, although this patient had never complained of diarrhea.She had suffered from constipation for about 3 years. As it had been a mild case, she had seldom taken cathartics orally. In 1943, Heilbrun described a special colitis caused by the daily and continuous ingestion of irritant cathartics over a period of at least 15 years which was usually localized to the colon, from the cecum to the proximal transverse area. There were irreversible changes such as shortening and an extremely smooth flat and atrophic mucosa of the right side of the colon resembled to burnt out ulcerative colitis in Heilbrun's cases which resulted in protein-losing gastroenteropathy and malabsorption associated with factitious diarrhea. Although our patient had used irregularly one or two tablets a day of the same cathartics as mentioned above for only half a year, she suffered from severe bloody diarrhea and had melanosis coli. Her complaint disappeared 7 days after the admisson by the therapy with antibiotics and dietary treatments. The fluoroscopic and endoscopic findings performed 21 days after admission were almost normal. In any case, we clinicians must emphasize that only a pretty small dose of cathartic tablet on the market used by many people arbitrarily without prescriptions should be able to damage severely mucous membrane and cells of neuromuscular system of the colon contrary to our expectations.
