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Cocaine-induced mesenteric ischaemia requiring small bowel resection
  1. Asya Veloso Costa1,
  2. Asiya Zhunus1,
  3. Rehana Hafeez1 and
  4. Arsh Gupta2
  1. 1Department of General Surgery, Princess Royal University Hospital, King's College Hospital NHS Foundation Trust, London, UK
  2. 2Department of Histopathology, Princess Royal University Hospital, King's College Hospital NHS Foundation Trust, London, UK
  1. Correspondence to Dr Asya Veloso Costa; asya.velosocosta{at}nhs.net

Abstract

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.

  • general surgery
  • poisoning
  • toxicology
  • small intestine
  • emergency medicine

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Footnotes

  • Contributors AVC, AZ and RH were part of the general surgical team looking after the patient. AVC wrote the manuscript. AZ obtained consent and edited the manuscript. RH supervised and reviewed the final manuscript. AG was involved in the initial reporting of pathology samples and produced histopathology images and findings for the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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