Indian J Gastroenterol DOI 10.1007/s12664-014-0481-z


The classic melanosis coli Aaysha Kapila & Pranav Patel & Omar Khan & Ravindra Murthy & Mark F. Young

# Indian Society of Gastroenterology 2014

Melanosis coli is a benign and a reversible condition, widely associated with the long-term usage of anthraquinonecontaining laxatives. These laxatives have been associated with colonic epithelial cell apoptosis which are further phagocytosed by the macrophages, forming lipofuscin containing macrophages, causing the pigmentation of the colonic mucosa. It can infrequently involve the duodenum, ileum, and jejunum [1]. Endoscopic examination of the colon classically demonstrates diffuse and extensive dark-colored pigmentation of the entire colon (Fig. 1a). Pathologic examination of the colonic mucosa is characterized by pigmented macrophages in the lamina propria (Fig. 1b). The pigmentation generally disappears within a year after cessation of anthraquinone laxatives. The association of melanosis coli with colorectal adenomas has been observed, but its association with colorectal cancer is controversial [2]. Physicians should discourage their patients from long-term usage of anthraquinone laxatives.

A. Kapila (*) Department of Internal Medicine, East Tennessee State University, Johnson City, TN 37614, USA e-mail: [email protected] P. Patel : M. F. Young Department of Gastroenterology, East Tennessee State University, Johnson City, TN 37614, USA O. Khan Department of Pathology, East Tennessee State University, Johnson City, TN 37614, USA R. Murthy Department of Gastroenterology, James H. Quillen VA Medical Centre, Johnson City, TN, USA

Fig. 1 a Endoscopic imaging demonstrates diffuse dark black and brown appearing colon, consistent with diagnosis of melanosis coli. b Biopsy specimen demonstrates macrophages laden with brownish pigment in the lamina propria

Indian J Gastroenterol

References 1. Banai J, Fenyvesi A, Gonda G, Petö I. Melanosis jejuni. Gastrointest Endosc. 1997;45:432–4.

2. Abendroth A, Klein R, Schlaak J, Metz KA, Dobos GJ, Langhorst J. Impressive picture of a melanosis coli after chronic anthraquinone laxative use—is there an increased risk for colorectal cancer? Z Gastroenterol. 2009;47:579–82.

The classic melanosis coli.

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