Subacute cholestatic hepatitis likely related to the use of senna for chronic constipation

Acta Gastroenterol Belg. 2005 Jul-Sep;68(3):385-7.

Abstract

We report a case of senna-induced cholestatic hepatitis which was not diagnosed at presentation. A 77 year old male was referred with abdominal pain, jaundice and elevated transaminase levels. A diagnosis of extrahepatic cholestasis was first suspected, due to the observation of a duodenal diverticulum and dilated proximal choledocus. However, the sphincterotomy did not improve cholestasis. At further evaluation, HBsAg was positive but serological work up was compatible with a healthy-carrier status. Further interrogation of the patient revealed a history of chronic senna intake to treat a chronic constipation. Liver biopsy showed bridging hepatocellular necrosis as well as canalicular cholestasis. Drug withdrawal resulted in a slow and progressive reduction in bilirubin levels and liver enzymes. In this case senna was likely the cause of a subacute cholestatic hepatitis exemplifying again the potential role of herbal related liver injury.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Biopsy
  • Cathartics / adverse effects*
  • Cathartics / therapeutic use
  • Chemical and Drug Induced Liver Injury / etiology*
  • Chemical and Drug Induced Liver Injury / pathology
  • Cholestasis, Intrahepatic / chemically induced*
  • Cholestasis, Intrahepatic / complications
  • Cholestasis, Intrahepatic / pathology
  • Chronic Disease
  • Constipation / drug therapy*
  • Humans
  • Male
  • Senna Extract / adverse effects*
  • Senna Extract / therapeutic use

Substances

  • Cathartics
  • Senna Extract