Abstract

Introduction: Cocaine abuse is rising in low income persons, black individuals, and persons ≥50. Cocaine-induced bowel ischemia and gastrointestinal injury are deadly findings that have been previously described separately in the literature. In this report, we present a case of small bowel ischemia, perforation, and upper GI hemorrhage occurring together in a 62-year-old incarcerated male with a 15-year history of cocaine abuse.

Case Report: The aforementioned male presented with a peritonitic abdomen followed by prompt surgical exploration, which revealed small bowel perforation repaired by excision but was left in discontinuity due to hypothermia. Subsequently, the patient developed an upper GI hemorrhage, for which he underwent esophagogastroduodenoscopy (EGD) and gastroduodenal artery embolization. He then underwent two additional exploratory laparotomies for anastomosis of his bowel and closure of his abdomen. 

Outcomes: Following a 7-week hospital stay, there was restoration of bowel function and the patient was discharged with plans for follow-up.

Discussion: While cocaine-induced bowel ischemia, perforation, and gastrointestinal hemorrhage have been described separately in the literature, this is the first report to our knowledge to describe all three such complications presenting concurrently. This patient’s history of GERD likely heightened his susceptibility to gastrointestinal ulcers, while his incarceration likely limited his access to antacids, increased his risk of substance abuse, and decreased his healthcare quality. Cocaine-induced gastrointestinal injury, especially in the setting of incarceration, is a life-threatening disease that requires rapid diagnosis and treatment to preclude invasive surgical management, extensive length of stays, and preventable long-term complications.