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Rare cause of acute abdomen–cocaine-induced small intestinal perforation with coexisting lower gastrointestinal bleed: an unusual presentation
  1. Sriram Deivasigamani1,
  2. Santhosh Irrinki1,
  3. Jimil Shah2 and
  4. Yashwant Sakaray1
  1. 1General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
  2. 2Medicine, Seth GS Medical College and KEM Hospital, Mumbai, India
  1. Correspondence to Dr Santhosh Irrinki; narayanairrinki{at}


Cocaine, an alkaloid, is an addictive drug and its abuse as a recreational drug is on the increasing side with its associated complications. Gastrointestinal complications, after cocaine abuse, are less known and need to be addressed since the abuse is on the rise and the existing evidence is scarce. We report a case of a 22-year-old male patient who presented with abdominal pain following a cocaine injection. On examination, signs of peritonitis were noted and laparotomy revealed a 2×1 cm perforation in the distal ileum. The unhealthy intestinal segment was resected and taken out as a double-barrel ileostomy. The patient had an episode of severe lower gastrointestinal bleeding on postoperative day 6. CT and colonoscopy revealed signs of ischaemic bowel and tissue biopsy showed oedematous, inflamed and haemorrhagic bowel mucosa. The patient was managed conservatively and is doing well under follow-up in a de-addiction centre.

  • gastrointestinal surgery
  • drugs misuse (including addiction)

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  • Contributors SD took part in conception, design and revision of the study. SI revised the manuscript critically and gave final approval of the version to be published. JS drafted the manuscript and revised the manuscript for intellectual content. YS revised the manuscript critically and ensured the accuracy of the study.

  • 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.