A Serendipitous Find: A Case of Cholangiocarcinoma Identified Incidentally After Acute Liver Injury Due to Cascara sagrada Ingestion.

The use of anthranoid laxatives such as Cascara sagrada can, in rare instances, produce a hepatitis that resolves with discontinuation of the offending supplement. However, the clinical presentation of abdominal pain, jaundice, clay-colored stools, and darkening urine can mimic the presentation of a variety of hepatobiliary illnesses, including cholangiocarcinoma. This case report describes a local patient diagnosed with an extrahepatic cholangiocarcinoma following workup for an acute hepatitis due to ingestion of large quantities of Cascara sagrada.

[Toxic hepatitis following consumption of the herbal medicinal product Cascara Sagrada]. / Toksisk hepatitis efter indtagelse af kosttilskuddet purshianabark.

Herbal medicinal products can cause toxic hepatitis. This case report presents a patient who developed severe toxic hepatitis with beginning liver failure following four weeks of consumption of the herbal medicinal product Cascara Sagrada. A similar case was reported from the United States. Cascara Sagrada is found in 30-40 herbal medicinal products in Denmark. We recommend that herbal medicinal products containing Cascara Sagrada be withdrawn from the market.

Cascara sagrada-induced intrahepatic cholestasis causing portal hypertension: case report and review of herbal hepatotoxicity.

Herbal medicines are gaining widespread popularity. Much of the public believes that botanical herbs are both harmless and useful for the treatment of a variety of symptoms. This belief stands in contrast with the fact that many herbal therapies have been shown to be toxic. In the present case report, cascara sagrada (CS) has been associated with the development of cholestatic hepatitis, complicated by portal hypertension. CS is a mixture of ingredients, among which is anthracene glycoside--an herbal agent that previously has been associated with chronic hepatitis. The liver injury in the case herein reported is believed to be related to either anthracene glycoside or one of the other constituents of CS.

Regional variation in the histological appearance of the small and large intestine of the rat following acute and chronic administration of Melo's Conquer Mixture.

The effect of acute and chronic administration of various doses of Melo's Conquer Mixture (MCM) on the histological appearance of the small and large intestine was investigated in albino Wistar rats. Obtained results show that at recommended therapeutic dose, MCM is able to evoke an acute inflammatory response, with infiltration of the mucosa and submucosa by neutrophils, lymphocytes and eosinophils. In addition, there was submucosal lymphoid follicle hyperplasia and increased mucus secreting cells. The severity of these changes were dependent more on prolonged administration than dose. These findings suggest strongly that MCM is a potential toxic agent. We therefore recommend further chemical analysis to identify the possible toxic agent(s) in this mixture.

Cleansing of the colon without enemas.

Several methods have been used to cleanse the large bowel prior to roentgen examination and rectoscopy for more than ten years. A method with administration of a salt solution (SALAX) in combination with different oral laxatives (Cascara sagrada, Dantron, Bisacodyl) without cleansing enemas is described. Hospitalized patients should have an individual preparation while ambulatory patients are almost completely cleansed if they carefully follow the given instructions.