S1889 Colon Cleansing for Weight Loss: A Case of Severe Pancolitis

Abstract

Introduction: Colon cleanses in the form of oral laxatives marketed as weight-loss tools are becoming increasingly popular. Here, we outline a case of a previously healthy 30-year-old female who presented with diarrhea and was found to have severe pancolitis after a 14-day colon cleanse in the form of an oral herbal supplement called ZuPoo. Case description/methods: The patient initially presented to the emergency department with diarrhea and abdominal pain that persisted 10 days after stopping a colon cleanse. On arrival, she was tachycardic to 140bpm, tachypneic to 40bpm, and febrile to 38.2°C. Labs were notable for a leukocytosis of 20,900 μl and a normal lactate of 1.4 mmol/L. Blood cultures and infectious stool panels including c dif were negative. CT scan of the abdomen showed diffuse severe pan colitis and moderate small bowel dilatation. She was started on IVF and empiric IV antibiotics and admitted. She underwent a sigmoidoscopy on day 2 with concern for inflammatory bowel disease showing mild to moderate inflammation with biopsies negative for active inflammation (Figure 1). Her diarrhea progressed, and she was persistently tachycardic despite heavy IV fluid resuscitation with a leukocytosis of 56,000 μl and a lactate of 9.6 mmol/L. On day 4 she became pulseless in asystole after an episode of large volume emesis. She was intubated and ROSC was achieved after 20 minutes. An x-ray of her abdomen showed pneumatosis intestinalis and she underwent emergent bowel resection. She had progressive multi-organ failure and 4-pressor shock. Over the following 3 days, she underwent multiple bedside laparotomies with bowel resections. She was treated with broad spectrum antibiotics and high dose steroids before the ultimate decision to withdraw care was made. Discussion: This case demonstrates a temporal relationship between a colon cleanse and severe prolonged diarrhea with pancolitis on imaging without a clear etiology otherwise. There is available data on the risks colonic irrigation for weight loss including dehydration, electrolyte imbalances, infection, and perforation. Information on the risks of herbal supplements used for colon cleansing, however, is not widely available and poorly studied. A 2016 study showed that 10.5% of women aged 23-35 used over the counter laxatives for weight loss. While studies in the past have outlined the dangers of laxative abuse, further research is needed to carefully elucidate the risks of commercially available herbal supplements marketed as colon cleanses for weight-loss.Figure 1.: Previously healthy 30-year-old patient presented with prolonged diarrhea after using an herbal colon cleanse for weight loss with a flexible sigmoidoscopy showing mild erythema, granularity, and decreased vascular pattern in the rectum and sigmoid colon.