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Enterocolitis associated with cocaine use.
C Neal Ellis1, William W McAlexander
1Department of Surgery, University of South Alabama, Mobile, Alabama, USA. nellis@usouthal.edu
Diseases of the Colon and Rectum
|October 18, 2005
Summary
Cocaine-associated enterocolitis typically emerges within three days of drug use, often affecting the proximal colon. While most cases resolve with nonoperative care, peritonitis requiring surgery carries a 50% mortality risk.
Area of Science:
- Gastroenterology
- Toxicology
- Colorectal Surgery
Background:
- Cocaine use is linked to severe gastrointestinal complications.
- Enterocolitis is a recognized, albeit uncommon, manifestation of cocaine abuse.
Purpose of the Study:
- To describe the clinical presentation and outcomes of cocaine-associated enterocolitis.
- To identify patterns of disease and treatment responses in affected patients.
Main Methods:
- Retrospective review of patient charts (1991-2001) with diagnoses of colitis or abdominal pain.
- Inclusion criteria: positive urine drug screen or documented cocaine use.
- Data collected: symptoms, physical findings, clinical study results, and patient outcomes.
Main Results:
- Eighteen patients were identified with cocaine-associated enterocolitis.
- Symptoms typically appeared within three days of last cocaine use.
- Computed tomography revealed inflammation or ischemia in 10 of 11 patients, predominantly in the proximal colon.
- Fifteen patients initially received nonoperative management; four required surgery for peritonitis, with a 50% mortality rate among surgical cases.
Conclusions:
- Cocaine-associated enterocolitis commonly presents within three days of use, with proximal colon involvement frequent.
- Nonoperative management is successful for the majority of patients.
- Peritonitis necessitating laparotomy is associated with a high mortality rate (50%).