INTRODUCTION: Diarrhea, gastro-enteritis and parasitic infections are highly prevalent in many parts of the world, especially in developing countries. About 1.5 million children die every year due to diarrhea. Diarrhea can be triggered by various enteric pathogens including viruses, bacteria and protozoa. Psidium guajava is a plant that is indigenous in Central America and parts of South America. In these tropical and subtropical countries, the guava plant is used as a food crop and as a medicinal plant. In the inland of Suriname it is used against diarrhea and other gastrointestinal symptoms. In a week’s time, two children were admitted to the ward with a suspicion of ileus after usage of a decoction of guava leaves for gastro-enteritis.
CASES: Two cases of patients are described who presented at the emergency room with a distended abdomen after usage of guava leaves decoction for gastro-enteritis. Abdominal x-rays showed in both cases suspicion of an ileus with a dilated colon and fluid levels. Feces cultures were negative for Salmonella, Shigella and Campylobacter. A nasogastric tube was placed; the patients were given nil per os and intravenous rehydration therapy. After a few days they were discharged in a clinical good condition.
DISCUSSION: Diarrhea and gastroenteritis are usually treated with commercially available drugs or traditional medicine remedies. This is the first time that ileus after using a guava leaves decoction is described, while ileus is a known complication after using commercial anti-diarrheal agents. Previous studies showed that Psidium guajava actually has an anti-diarrheal and anti-motility effect. This anti-motility effect might be the cause of the ileus. This case report also mentions the importance of being aware of the usage of alternative medicine and its side effects, especially in tropical countries.