Challenges in the Diagnosis and Management of Methamphetamine-Induced Intestinal Ischemia in a General Hospital With...

Non-occlusive mesenteric ischemia (NOMI) is an abdominal emergency with high mortality, the confirmation of which usually relies on computed tomography, a resource unavailable in many second‑level hospitals in Mexico. We report a case of a 37‑year‑old man with no prior comorbidities and a four‑year history of chronic methamphetamine use who presented with diffuse abdominal pain of 10 days' duration, fever, and incipient shock. Plain abdominal radiography demonstrated massive colonic distention. As computed tomography was unavailable and signs of peritoneal irritation were present, urgent exploratory laparotomy was performed, revealing patchy transmural necrosis of the entire colon with viable small bowel. Total colectomy and ileostomy were undertaken. Despite intensive vasopressor support, the patient died of refractory vasoplegic shock. This case underscores that NOMI secondary to methamphetamine use can occur in young patients and rapidly progress to massive colonic necrosis. It also highlights the need to maintain a high index of suspicion and proceed to early surgical exploration when the clinical scenario warrants it, even in settings with limited diagnostic resources, to avoid fatal delays.