Citrullus colocynthis as the Cause of Acute Rectorrhagia

Introduction. Citrullus colocynthis Schrad. is a commonly used medicinal plant especially as a hypoglycemic agent. Case Presentation. Four patients with colocynth intoxication are presented. The main clinical feature was acute rectorrhagia preceeded by mucosal diarrhea with tenesmus, which gradually progressed to bloody diarrhea and overt rectorrhagia within 3 to 4 hours. The only colonoscopic observation was mucosal erosion which was completely resolved in follow-up colonoscopy after 14 days. Conclusion. The membranolytic activity of some C. colocynthis ingredients is responsible for the intestinal damage. Patients and herbalists should be acquainted with the proper use and side effects of the herb. Clinicians should also be aware of C. colocynthis as a probable cause of lower GI bleeding in patients with no other suggestive history, especially diabetics. 1. Introduction Citrullus colocynthis Schrad., from the family Cucurbitaceae, popularly named bitter apple or bitter cucumber in English and called Hendevaneh Abujahl (Abujahl watermelon) or Kadu Hanzal (bitter ground) in Persian, is a well-known medical plant used alone or in compounds for many medical purposes. Different parts of the plant including seeds, fruit, root, stem, and leaves, used as either aqueous or oil extracts, dried or fresh, are believed to have antidiabetic [1–6], antihyperlipidemic [7, 8], laxative [1, 3, 9], anti-inflammatory [9], analgesic [9], vermifuge [5], hair-growth-promoting [10], antibacterial [11], antifungal [11], and antioxidant properties [12]. In spite of multiple medical benefits, some of the most frequently reported complications such as colic, diarrhea, hematochezia, nephrosis, vomiting, and liver impairment [4, 13, 14] have placed C. colocynthis amongst the top 10 toxic plants [14]. In 1989, three cases of toxic acute colitis following ingestion of C. colocynthis were reported by Goldfain et al. The main clinical presentation was dysenteric diarrhea. The colonoscopic observations were mucosal congestion and hyperemia with abundant exudates, but no ulceration or pseudopolyp formation, which disappeared within 14 days in all patients [15]. Contreras et al. also reported colocynth poisoning as a rare cause of acute diarrhea syndrome in 1996 [16]. Khan et al. reported 5 cases of toxicity due to consumption of colocynth in Saudi Arabia over a 2-year period who presented with acute severe bloody diarrhea [17]. 2. Case Presentation 2.1. Patient I A 28-year-old white housewife, with body mass index of 24？kg/m2, presented to the emergency department (ED) with rectorrhagia