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Public Health Advisory

Department of Surgery

Ospital ng Maynila Medical Center

August 6, 2001

Beware of Santol Seeds!

Do not Swallow Them!

Swallowing Santol Seeds as a Health Problem
What can happen after one swallows santol seeds?
Reynaldo O. Joson, MD

Santol Grows Everywhere
Janix de Guzman, MD

Case of the Deadly Santol Seeds
Rafael R. Castillo, MD (Philippine Daily Inquirer - Medical Files - September 8, 2001)

Case of the Deadly Santol Seeds - A Rejoinder
Page 1][Page2]
Rafael R. Castillo, MD (Philippine Daily Inquirer - Medical Files - August 24, 2002)

Please donít swallow santol seeds, they could be deadly
Agriculture, Manila Bulletin - August 9, 2002

Swallowed santol seeds causing surgical abdomen - A case report
Oliver Leyson, MD, Edgardo Penserga, MD, Reynaldo O. Joson, MD

Swallowing Santol Seeds as a Health Problem
What can happen after one swallows santol seeds?
Reynaldo O. Joson, MD

What can happen after one swallows santol seeds?

Most of the time, the santol seeds will be passed out through the anus during defecation.

However, santol seeds inside the intestines can cause complications.

They may cause obstruction by sticking together to form a hard bolus of seeds or by completely plugging the intestinal lumen that has been previously and partially constricted by a disease like a tumor or tuberculosis.

They may cause perforation. After the fibers surrounding the seed have been digested, the remaining shell is usually sharp at its two ends. These sharp ends can perforate a normal intestinal wall or an intestinal wall that has been previously weakened by a disease or a degenerative condition such as a diverticulosis.

Perforations of the intestine will result in spillage of feces into the peritoneal cavity causing peritonitis or infection of the cavity of the abdomen. If not controlled early enough by an operation, the peritonitis can cause death through septicemia (generalized body infection via the blood stream).

Intestinal obstruction and perforations caused by swallowed santol seeds need an operation. The operative procedure usually consists of resecting or cutting the involved bowels or intestines. After resection, depending on the circumstances in the intestines, the surgeon may either anastomose (reconnect the cut ends) or make a temporary colostomy (an opening in the abdominal wall which will serve as a temporary anus).

Our experience with swallowed santol seed is that complications are usually seen in older age group where there is usually a higher incidence of abnormality in the intestines compared to the younger population.

Our experience also shows that death can occur as a direct result of swallowing santol seeds. The death of these patients are definitely preventable if only people do not swallow santol seeds.

We don't know why people swallow santol seeds. The reason may be accidental or intentional because of some satisfaction derived from swallowing these seeds. Whatever be the reason, we advise the public NOT to swalllow santol seeds if they want to avoid the complications that may result with swallowing; if they want to avoid an operation; and most important of all, if they want to avoid a premature death.

Santol Grows Everywhere
Janix de Guzman, MD

I always wonder when I was a child why Santol Trees grow almost everywhere in our country. Everywhere you go there is a santol tree. This keeps on until now. Recently, now that I am a Medical Practitioner, I thought I have found my query.

A 55-year-old female was brought in at the Ospital ng Maynila Medical Center (OMMC) complaining of abdominal pain for three days and sudden abdominal distention. This happened after she had eaten three santol fruits without wasting anything except the peel.. Fortunately for this lady, she was brought at an early stage and to a reputable hospital. She was eventually operated. The doctors found an obstruction in the large bowel with a hole just before the obstruction. Three to four santol seeds were found lodged, impacted on that area, with the tip of one seed protruding on the wall of the bowel. The doctors believe that this may be the cause of the obstruction and the perforation.

This case was not an isolated one. On review of the Medical Records of OMMC, I found out that on the average, four to five cases of "Stercoral Perforations" necessitating operations were performed each year. The age of these patients ranges from 45 to 65. Doctors believe that at this age group abnormalities on the large bowels are most common that may predispose these patients to such cases. No predilection as to the sex of the patients was found. The outcome or prognosis of each case depends most importantly to the time of consult.

OMMC, especially the Department of Surgery has started disseminating information about the dangers of swallowing santol seeds at least on its hospital level. Elderly patients who had consulted on the Out-Patient Department, Section of Surgery were advised not to swallow santol seeds, especially now where you can see santol everywhere. Although there are no cases yet of "Stercoral Perforations" on young patients handled by this hospital, still we advised these patients. As we have learned, common Filipino practices were done at the very beginning at an early age, and as they grow older, these habits are hard to break.

As I look back, Filipinos are very lucky indeed for we have a rich soil and to those who have passed the seeds you are very lucky also. "But beware there are consequences if you only rely on luck. Now I know why santol are everywhere.

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