Portal vein thrombosis related to Cassia angustifolia.

Abstract

INTRODUCTION:

Cassia angustifolia (Senna), used as a laxative, is a plant from the Fabaceae family. It includes hydroxyanthracene glycosides, also known as Senna Sennoside. These glycosides stimulate the peristalsis of the colon and alter colonic absorption and secretion resulting in fluid accumulation and expulsion. In the literature, there are reports illustrating the hepatotoxic effects of Cassia angustifolia but there is no report of portal vein thrombosis caused by Cassia Angustifolia.

CASE REPORT:

A 42-year-old woman was admitted to the emergency department with a five-day history of worsening epigastric pain, anorexia, episodic vomiting, and intermittent fever. She reported that she had boiled dried senna leaves she had bought from herbalists and drank approximately 200 mL daily for two years. Color Doppler screening found an echogen thrombus obliterating portal vein bifurcation and the right branch. The lumen was obstructed at this level and there was no blood flow through it. Treatment with thrombolytics was unsuccessful.

DISCUSSION:

Severe hepatotoxicity senna use is unusual. The cause of senna-related hepatotoxicity is unclear but could be explained by the exposure of the liver to unusual amounts of toxic metabolites of anthraquinone glycosides.

CONCLUSION:

Chronic use of Cassia angustifolia may rarely be associated with portal vein thrombosis.

• Authors: Secgin Soyuncu, Yildiray Cete, Ali E Nokay
• Journal: Clinical toxicology (Philadelphia, Pa.) (Clin Toxicol (Phila)) Vol. 46 Issue 8 Pg. 774-7 (Sep 2008) ISSN: 1556-3650 [Print] England
• PMID: 19238740 (Publication Type: Case Reports, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Anticoagulants
• Laxatives
• Plant Extracts

Topics

• Adult
• Anticoagulants (therapeutic use)
• Female
• Humans
• Laxatives (adverse effects)
• Plant Extracts (adverse effects)
• Plant Leaves
• Portal Vein (diagnostic imaging)
• Senna Plant
• Thrombolytic Therapy
• Treatment Failure
• Ultrasonography, Doppler, Color
• Venous Thrombosis (chemically induced, diagnostic imaging, drug therapy)