Melanozis ilei ve melanozis koli birlikteliği: Olgu sunumu

Melanosis of the colon is not uncommon, but black pigmentation of the small intestine is extremely rare. We report a case in which we observed melanosis not only in the colon but in the ileum as well following the use of mixed herbal tea including senna leaves. A 53-year-old male presented with abdominal cramps and bloating, especially after eating. He had suffered from constipation for 2-3 years and these symptoms had increased in the last 2 months. He had used tea from senna leaves for one year and then a mixed herbal tea for the last year to achieve defecation. This patient had no other systemic diseases. In his colonoscopic examination, we noted the typical appearance of melanosis coli. We observed that the hyperpigmentation was more intense in the cecum. Interestingly, the pigmentation was also seen in the ileum. Multiple biopsies were taken and sent for pathology. On microscopic and immunohistochemistry examination, reaction was seen on histiocytes with Mac 387 and focal reaction on melanophages with S100 on the samples taken from both the colon and small intestine. Based on the histological findings, the diagnosis of melanosis coli and melanosis of the small intestine was made. Melanosis of the colon is not uncommon and has been associated especially with the ingestion of anthracene-line laxatives (including cascara, senna, aloes and rhubarb), although it can be observed in patients without such history. Our patient had consumed a mixed herbal tea for the last year. He had also used tea from senna leaves for one year before using the mixed herbal tea. Melanosis of the small intestine is an extremely rare finding in the most readily visualized areas during routine endoscopic evaluation, including the duodenum or distal ileum. Why the deposition of melanin pigments in the small intestine is rare remains unclear. The less frequent observation of melanosis in the small intestine compared to the colon may be attributed to the facts that the pigment location is not uniform, maybe due to differences in macrophage distribution between the colon and ileum, or because the ileum is less visualized during a routine colonoscopy