Image and Video clip of Severe Melanosis Coli

Video Endoscopic Sequence 1 of 5.

Image and Video clip of Severe Melanosis Coli.

A 32 year-old female, underwent a colonoscopy because of had been defecating for several months abundant mucus in her stool, colonoscopy displays entire length of the colon from the rectum to the cecum of black color.

The patient consumed several liters of aloe vera per day for several years.

The results of the colonoscopy showed diffuse staining of the entire colonic mucosa, with a very dark discoloration. The mucosa of the terminal ileum was normal . Histopathologic analysis of the colonic biopsies confirmed the presence of severe melanosis.

Download the video clips by clicking on the endoscopic images, if you wish to observe in full screen, wait to be downloaded complete then press Alt and Enter for Windows media, Real Player Ctrl and 3.  Configure the windows media in repeat is optimal. All endoscopic images shown in this Atlas contain video clips. We recommend seeing the video clips in full screen mode. 

 

Melanosis Coli.

Video Endoscopic Sequence 2 of 5.

Melanosis Coli.

Colonoscopy showed diffuse staining of the entire colonic mucosa, with a very dark discoloration . The mucosa of the terminal ileum was normal . Histopathologic analysis of the colonic biopsies confirmed the presence of severe melanosis.

The most common cause of melanosis coli is the extended use of laxatives, and commonly anthraquinone containing laxatives such as Senna and other plant glycosides. The anthranoid laxatives pass through the gastrointestinal tract unabsorbed until they reach the large intestine, where they are changed into their active forms. The resulting active compounds cause damage to the cells in the lining of the intestine and leads to apoptosis (a form of cell death). The damaged (apoptotic) cells appear as darkly pigmented bodies that may be taken up by scavenger cells known as macrophages. When enough cells have been damaged, the characteristic pigmentation of the bowel wall develops. The condition can develop after just a few months of laxative use.

 

Endoscopy of Severe Melanosis Coli.

Video Endoscopic Sequence 3 of 5.

Endoscopy of Severe Melanosis Coli.

 However, other causes are identified, including an increase in colonic epithelial apoptosis Endoscopically, the mucosa may show a brownish discoloration in a moire pattern.

Melanosis coli is a brownish discoloration of the colon mucosa, caused by the accumulation of pigment in macrophages within the lamina propria. First described in the early 19th century, the pigment was initially thought to be melanin, but it was later found to be lipofuscin
deposited in macrophages within the lamina propria as a result of apoptosis. residual lipofuscin bodies results. When sufficient cells have been damaged, the distinctive pigmentation of the bowel mucosa develops. Such a sequence of damage has been demonstrated in guinea pigs exposed to anthraquinones. Histologically, the number and size of macrophages within the lamina propria are increased, and the greatest amount of pigment is found in macrophages farthest from the lumen. It is possible that this relatively selective colonic mucosal involvement may reflect the qualitative or quantitative differences in colonic microbial flora (as opposed to the small intestine). Alternatively, some other structural difference in colonic cells or their response to anthraquinone cathartics may be responsible for the colonic mucosal regionalization of the lipofuscin pigment deposition.

 

Normal terminal ileum

Video Endoscopic Sequence 4 of 5.

Normal terminal ileum

Terminal ileum, in this case of a melanosis coli not appear to be affected.

The term melanosis in the gastrointestinal tract refers to the accumulation of pigment deposits in the mucosa. Melanosis of the colon is not uncommon and has been associated with certain conditions, however melanosis of the small intestine is extremely rare.

Melanosis Coli.

Video Endoscopic Sequence 5 of 5.

Melanosis Coli.

This is dark pigment staining of the colonic wall is known as melanosis coli, the term initially established by Dr. Rudolf Virchow in 1870. While the name has persisted it has long been recognized that the pigment staining is not due to increased melanin deposits as initially thought but instead due to lipofuscin, a cellular degradation product. The lipofuscin is found in histiocytes or macrophages and is thought to represent degradation products from cells undergoing apoptosis. The association between melanosis coli and the use of cathartics that contain the active ingredient, anthraquinone, has been established. In laboratory settings, anthraquinones causes apoptosis of guinea pig enterocytes leading to lipofuscin accumulation. The pigment accumulation is documented to be reversible if intake of the offending agent is avoided. Melanosis typically is most intense in the cecum and diminishes in intensity down the length of the colon. Characteristically, the terminal ileum is devoid of any pigment uptake as seen here.

Melanosis coli and pedunculated polyp of the sigmoid

Video Endoscopic Sequence 1 of 10.

Melanosis coli and pedunculated polyp of the sigmoid

This 52 year-old female, for two years, had been using aloe vera capsules for constipation.

A complete colonoscopy to the terminal ilium was performed. Two polyps was detected, one in the iliocecal valve and the other in the sigmoid.

A complete colonoscopy in retrofletion is performed from the cecum to the rectum, watching the entire colon with this maneuver.

 

Melanosis coli

 

 

 

gastric cicatrization caused by ingestion of

Video Endoscopic Sequence 2 of 10.

Pedunculated sigmoid polyp.

The contrast of color between the polyp and melanosis coli the polyp not acquire the brown color.


Image and Video clip of Melanosis Coli.

Video Endoscopic Sequence 3 of 10.

Image and Video clip of Melanosis Coli.


 

Image and Video clip of Melanosis Coli.

Video Endoscopic Sequence 4 of 10.

Image and Video clip of Melanosis Coli.

 

 

The cecum, the intensity of the pigment and the ileocecal valve is observed.

Video Endoscopic Sequence 5 of 10.

The cecum, the intensity of the pigment and the ileocecal valve is observed.

 

The terminal ileum which is not pigmented.

Video Endoscopic Sequence 6 of 10.

The terminal ileum which is not pigmented.

 

 

Endoscopy of Melanosis Coli.

Video Endoscopic Sequence 7 of 10.

Endoscopy of Melanosis Coli.

It appears brownish with visible lymphoid follicles between paler areas.

 

Melanosis coli observed in retroflexed colonoscopy

Video Endoscopic Sequence 8 of 10.

Melanosis coli observed in retroflexed colonoscopy

In this video a complete retroflexed colonoscopy is observed from the cecum to the rectum watching the entire colon.

 

 

Polypectomy of sigmoid polyp

Video Endoscopic Sequence 9 of 10.

Polypectomy of sigmoid polyp

Sigmoid colon polyp in which is carried out diathermy snare polypectomy.

 

The pedicle is being cauterized

Video Endoscopic Sequence 10 of 10.

The pedicle is being cauterized


 

Vitiligo Ileocecal Valve

Video Endoscopic Sequence 1 of 5.

"Vitiligo Ileocecal Valve"


We have called this term because of the contrast that makes melanosis coli with the light color of the valve which gives an appearance of vitiligo giving a peculiar image.

Endoscopic View of Melanosis Coli

Endoscopic View of Melanosis Coli

 

 

Melanosis Coli. Vitiligo Ileocecal Valve

Video Endoscopic Sequence 2 of 5.

Melanosis Coli. "Vitiligo Ileocecal Valve"

Diffuse darkbrown punctuate pigmentations in the cecum mucosa.

 

Severe Melanosis Coli

Video Endoscopic Sequence 3 of 5.

Melanosis Coli. "Vitiligo Ileocecal Valve"

Severe Melanosis Coli

 

Normal terminal ileum.

Video Endoscopic Sequence 4 of 5.

Normal terminal ileum.

The pigment in melanosis coli is localized within the colon as there is usually no pigment deposition in the small intestine Anthraquinone laxatives cause damage to the colonocytes; the damaged organelles are sequestrated in the autolysosomes of macrophages and result in lipofuscin bodies. Since the small bowel, especially the, terminal ileum, is rich in macrophages there is no reasonable explanation for small bowel sparing by this process. It is
possible that the rich microbial flora in. the colon is responsible for the difference Another explanation may be the structural difference between colonocytes and
enterocytes, which have villi and a more
.developed brush border.

 

Endoscopic Image and video clip of Melanosis Col Melanosis Coli. "Vitiligo Ileocecal Valve

Video Endoscopic Sequence 5 of 5.

Endoscopic Image and video clip of Melanosis Col Melanosis Coli. "Vitiligo Ileocecal Valve"

Colonoscopy showing diffuse brownish pigmentation of the
colonic mucosa compatible with melanosis coli.

 

Melanosis Coli.

Video Endoscopic Sequence 1 of 2.

Melanosis Coli.

This is the photograph of the colon, and there is an
extremely dark appearance to the wall of the colon. This is
seen in patients who have taken laxatives over many years
and the pigment from the laxative gets deposited in the wall of the bowel giving an extremely dark appearance to it.

A case of severe m. coli that developed secondary to the use of anthroquinone laxatives, sold as herbal supplements with a goal of optimizing colon health.

Severe case of melanosis coli, developed secondary to the use of anthroquinone laxatives sold as herbal supplements.


 

Melanosis Coli.

Video Endoscopic Sequence 2 of 2.

Melanosis Coli.

Melanosis coli is a darkening of the colonic mucosa caused by the accumulation of lipofuscin particles within the macrophages of the lamina propria of the colonic mucosas a result of long term exposure to anthraquinone-containing laxatives. This endoscopic finding is pathognomonic for laxative abuse and is reversible.

The patient reported having used an herbal preparation that was sold on several websites and was marketed as “promoting regular, healthy, and complete bowel movements.”
Among the ingredients for this “intestinal formula” are aloe, senna, and cascara.

However, there are many other herbal supplements containing ingredients that can be potentially harmful, such as ephedra, which was widely available in the U.S. until it was eventually banned by the FDA in December 2003 due to its risk of cardiovascular adverse effects (AEs).6
This case illustrates the risk associated with the current situation in the U.S., where medications extracted from plants might not be allowed to be marketed as medications; however, they can be widely sold as dietary supplements while keeping all their medicinal properties
and AEs. It has strongly encourage patients to be aware of these potential risks.

 

Melanosis Coli.

Melanosis Coli.

Pronounced Pigmentation of colonic mucosa. Sequel of chronic use of laxative of the anthraquinone group, which includes cascara sagrada, aloe, rhubarb, senna and fragula.

Melanosis coli develops from chronic use of anthracene cathartic agents. The endoscopic appearance of melanosis coli can be quite varied. It may also occur in patients with inflammatory bowel disease.

Many people incorrectly believe that daily defecation is necessary and complain of constipation if stools occur less frequently. Others are concerned with the appearance (size, shape, color) or consistency of stools. Sometimes the major complaint is dissatisfaction with the act of defecation or the sense of incomplete evacuation after defecation. Constipation is blamed for many complaints (abdominal pain, nausea, fatigue, anorexia) that are actually symptoms of an underlying problem (eg, irritable bowel syndrome [IBS], depression). Patients should not expect all symptoms to be relieved by a daily bowel movement, and measures to aid bowel habits should be used judiciously.

Obsessive-compulsive patients often feel the need to rid the body daily of “unclean” wastes. Such patients often spend excessive time on the toilet or become chronic users of cathartics.

 

Melanosis Coli and Diverticulum.

Melanosis Coli and Diverticulum.

Melanosis coli has been associated with the chronic use of anthroquinone laxatives. These include several plants, such as aloe, cascara, and senna. Aloe plants are members of the lily family, of which the aloe vera plant is the most common. Cascara sagrada is the common name of the
California buckthorn (Rhamnus purshianus), a shrub that grows in the Pacific Northwest. The bark of the cascara sagrada shrub and juice from the leaves of aloe plants have been used for medicinal purposes. Folk medicine has historically used both as laxatives.

On November 5, 2002, the U.S. Food and Drug Administration (FDA) issued a final ruling stating that aloe and cascara sagrada cannot be labeled or sold as stimulant laxatives in over-the-counter (OTC) drug products due to a lack of research on safety and efficacy. All
OTC medications containing these ingredients have not been available since then. Research about the efficacy and safety of senna was submitted to the FDA, and sennacontaining products were allowed to stay in the OTC category.


Endoscopic View of Melanosis Coli

Video Endoscopic Sequence 1 of 8.

Endoscopic View of Melanosis Coli

Pubmed: Melanosis coli--a harmless pigmentation or a precancerous condition?

The presence of identical pigment in macrophages of
pericolonic lymph nodes has been reported. This case
implies that the melanosis pigment-laden macrophages
formed in the lamina propria of the colon pass to the
regional lymph nodes and may explain the observation of
similar pigment-laden macrophages in other sites.

 

Melanosis Coli

Video Endoscopic Sequence 2 of 8.

Melanosis Coli.

Anthranoid-containing herbal laxatives damage epithelial
cells, leading to changes in absorption,secretion and
motility. They can induce cell loss, shortening of mucosal
crypts and increased cell proliferation. It remains
controversial whether melanosiscoli is associated with an
increased risk for colorectal cancer.

 

Melanosis Coli

Video Endoscopic Sequence 3 of 8.

Immersion Colonoscopy and Melanosis Coli.

Animal and human studies have shown an association between m.coli and the chronic use of anthraquinone laxatives, such as cascara sagrada, aloe, senna, rhubarb, and frangula. The discoloration often appears within 4 months of use and is observed in up to 70% of chronic
users of implicated laxatives.

 

Melanosis Coli

Video Endoscopic Sequence 4 of 8.

Immersion Colonoscopy and Melanosis Coli.

Earlier concerns about a possible relationship between m. coli and the development of colonic neoplasia have not been substantiated in prospective studies

 

Melanosis Coli

Video Endoscopic Sequence 5 of 8.

Endoscopic Image of Melanosis Coli.

Colonoscopy showing diffuse brownish pigmentation of the
colonic mucosa compatible with melanosis coli.

 

Melanosis Coli

Video Endoscopic Sequence 6 of 8.

High power view of brown pigment inside of macrophages
at the lamina propria.

Macrophages contain brown lipofuscin and lysosomal debris.

 

Melanosis Coli

Video Endoscopic Sequence 7 of 8.

High power view of brown pigment inside of macrophages
at the lamina propria.

Melanosis Coli

Video Endoscopic Sequence 8 of 8.

There are chronic inflammatory changes and macrophages.
10x.

Melanosis Coli and Diverticulae

Video Endoscopic Sequence 1 of 2.

Melanosis Coli and Diverticulae.

 

Melanosis Coli and Diverticulae.

Secuencia Video Endoscópica 2 de 2.

Melanosis Coli and Diverticulae.

 

© 2000 - 2017 gastrointestinalatlas.com
San Salvador, El Salvador | Contact