Ischemic Colitis following Mesotherapy in an Overweight Patient

Ischemic colitis after mesotherapy combined with anti-obesity medications.

Kim JB, Moon W, Park SJ, Park MI, Kim KJ, Lee JN, Kang SJ, Jang LL, Chang HK.

World J Gastroenterol. 2010 Mar 28;16(12):1537-40.

• Mesotherapy as well as anti-obesity medications are advocated as the newest in body contouring and weight loss. While the latter is effective and has side effects, the former is proposed because even if its efficacy has yet to be proven, risks are claimed to be low.

• Side effects of anti-obesity medication include:

1. increased blood pressure
2. headache
3. constipation
4. insomnia…

• Side effects of mesotherapy include:

1. bruising
2. edema
3. skin necrosis
4. abdominal hematoma at site of injection
5. liver toxicity
6. demyelination of nerves
7. atypical mycobacterial infection…

• The authors report a 39 year old healthy female with no comorbidities or risk factors other than being overweight (Body Mass Index (BMI) of 29.2 Kg/m2) who developed ischemic colitis (after passing blood in the stools for 12 hours) 8 days after undergoing mesotherapy while taking anti-obesity medications (not specified). The diagnosis was suspected on colonoscopy and confirmed by mucosal biopsy. The outcome was however favourable with complete resolution of the condition.

• Because this side effect has not been described in patients taking anti-obesity medication alone or undergoing mesotherapy alone, this effect highlights the potential for developing a non-obstructive blood vessel disorder. Some types of anti-obesity medication such as fenfluramine and phentermine can cause ischemic colitis when taken alone (these were not the class of medication taken by the authors, although the exact medication is not mentioned). Mesotherapy would have caused vasoconstriction, due perhaps to the anesthetic solution (lidocaine, epinephrine) injected for pain relief.

• We chose to highlight this article, even if it is not in a dermatological journal because it highlights additive side effects, when mesotherapy and anti-obesity medications are taken together. Ischemic colitis is life-threatening and thus a major side effect. A fatal outcome is more likely in older patients. Further studies are needed to explain the pathophysiology of its occurence and whether these two therapeutical modalities should be associated. For now, personally speaking, it wouldn’t be difficult to choose from a purely proven effectiveness point of view. (more about mesotherapy)