A Novel Case of Ischemic Colitis in the Setting of Kratom Use: A Case Report.

INTRODUCTION: Kratom is an herbal preparation - generally an extract, capsule, chew, or smoking substrate - made from the leaves of a tropical tree (Mitragyna speciosa) that is indigenous to Southeast Asia. Its physiological effects are complex and dose dependent: low doses mimic stimulants, while higher doses have sedative and analgesic effects. Although injury and failure of various organs have been reported with kratom use across multiple case study analyses, gastrointestinal involvement has been rarely documented.

CASE PRESENTATION: We present a 26-year-old female with no past medical history, no risk factors for intestinal ischemia, and an addiction to the commercial substance, kratom, who presented for 1 day of bright-red bloody diarrhea and bilious vomiting, and several weeks of intermittent sharp abdominal pain. Colonoscopy showed decreased mucosa vascular pattern in watershed areas of the colon and a splenic flexure that was so ulcerated it could not be safely traversed.

CONCLUSION: Given the lack of concomitant risk factors and comorbidities, as well as the timing of her symptoms beginning well before she started any medications, our most likely patient developed ischemic colitis due to her kratom use. This is further supported by her repeat colonoscopy 2 months after quitting kratom, which showed complete resolution. We would advise vigilance for possible bowel ischemia in those using kratom, a substance on which there is currently limited knowledge.