Portal vein thrombosis related to Cassia angustifolia.
BACKGROUND
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.


METHODS
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.


CONCLUSIONS
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.


CONCLUSIONS
Chronic use of Cassia angustifolia may rarely be associated with portal vein thrombosis.
Soyuncu
Secgin
S
Department of Emergency Medicine, Akdeniz University Faculty of Medicine, Dumlupinar Bulvari, 07059 Antalya, Turkey. ssoyuncu@akdeniz.edu.tr
Cete
Yildiray
Y
Nokay
Ali E
AE
D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use; D005260:Female; D006801:Humans; D054368:Laxatives / Q000009:adverse effects*; D010936:Plant Extracts / Q000009:adverse effects; D018515:Plant Leaves; D011169:Portal Vein / Q000000981:diagnostic imaging; D029846:Senna Plant; D015912:Thrombolytic Therapy; D017211:Treatment Failure; D018615:Ultrasonography, Doppler, Color; D020246:Venous Thrombosis / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000188:drug therapy
D000925:Anticoagulants; D054368:Laxatives; D010936:Plant Extracts