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An increasing variety of alternative health care products (defined as "over-the-counter," nonprescribed herbal medicines) are taken by patients for a plethora of reasons. Unfortunately these self-prescribed remedies are seldom considered by the patient to be medications and as a result it has been noted that 70 per cent of patients do not reveal herbal use to their allopathic practitioners or hospital personnel. The rapid growth of this herbal self-therapy has important implications for the practice of surgery. A case of post-laparoscopic cholecystectomy bleeding in a patient taking Gingko biloba is reported. This preparation has been reported to cause spontaneous bleeding and may interact with anticoagulants and antiplatelet agents. Other herbal medicines have also been associated with potential increased bleeding including garlic, feverfew, ginger, and ginseng. It is vital for surgeons to be apprised of all substances ingested by patients, to be cognizant of their potential adverse effects and drug interactions, and to be familiar with their therapeutic modality, all of which will help to optimize therapeutic approaches and improve patient outcome.
THERE ARE MANY alternative health care products (defined as "over-the-counter," nonprescribed herbal medicines) taken by patients for a plethora of reasons.1 These products, however, are seldom considered by the patient to be medications upon inquiry during a routine history and physical examination. Coincidingly, this area of herbal therapy is one that is rarely inquired about by the surgeon. These products are sold over the counter and are self-administered in the presence or absence of illness. The beneficial effects derived from these products have been largely supported through anecdotal experience, although a few preparations have been studied in random prospective trials. Patients and health care professionals are often unaware that these products can be detrimental, posing risks for patients undergoing anesthesia or surgical procedures. For example at least four reports of spontaneous bleeding in association with the use of Gingko biloba have been published.2-5 This evidence supports a recommendation that an association between a patient's medications and perioperative hemostasis issues should be taken into consideration.
Case Report
A 34-year-old black man presented to the Mercy Hospital of Philadelphia General Surgical Service after initial evaluation by his primary care physician. His complaints included a 3-week history of right upper quadrant pain with associated nausea and...