Cocaine-induced mesenteric ischaemia requiring small bowel resection

• Published in: BMJ case reports 2021-01, Vol.14 (1), p.e238593
• Main Authors: Veloso Costa, Asya, Zhunus, Asiya, Hafeez, Rehana, Gupta, Arsh
• Format: Article
• Language: English
• Subjects: Abdomen; Blood clots; Blood tests; Case Report; Case reports; Cocaine; Cocaine-Related Disorders - complications; Digestive System Surgical Procedures; Edema; Fistula; Hemoglobin; Humans; Intensive care; Ischemia; Laparotomy; Male; Mesenteric Vascular Occlusion - etiology; Mesenteric Vascular Occlusion - surgery; Middle Aged; Ostomy; Pain; Patients; Recreational drugs; Risk factors; Small intestine; Surgery; Thrombosis; Young adults
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2020-238593

Cocaine use causes profound vasoconstriction leading to various systemic complications. Gastrointestinal complications such as mesenteric ischaemia are difficult to recognise and may result in serious consequences if not treated promptly. We report on the case of a 47-year-old man presenting with mesenteric ischaemia on a background of acute on chronic cocaine consumption, where diagnosis was not evident until second presentation. He underwent an emergency laparotomy with small bowel resection and jejunostomy formation and made a good recovery with eventual reversal surgery. The literature on cocaine-induced bowel ischaemia shows significant variability in presentation and outcome. Laboratory investigations are non-specific, and early recognition is vital. Given the increasing recreational use of cocaine in the UK, it is imperative to have a high clinical index of suspicion for mesenteric ischaemia in patients presenting with non-specific abdominal pain, and to ensure a detailed social history covering recreational drug use is not forgotten.