Cocaine-associated non-occlusive ischemic colitis mimicking appendicitis in a young woman: a case report

Cocaine can trigger severe splanchnic vasoconstriction and non-occlusive mesenteric ischemia, occasionally mimicking common surgical emergencies. A previously healthy 27-year-old woman presented with 5 days of worsening right lower quadrant pain, nausea, and fever. CT suggested appendicitis. Laparoscopy revealed a normal appendix but ischemic ileum and cecal gangrene, requiring conversion to laparotomy and ileocecal resection with stoma. Histopathology showed transmural ischemic necrosis without vascular occlusion. Postoperatively, the patient disclosed recent cocaine use. Cocaine-related ischemia often affects young adults without vascular risk factors, may be radiologically subtle, and carries higher mortality when diagnosis is delayed. In young adults with unexplained acute abdomen, clinicians should consider cocaine-associated ischemia and obtain toxicology screening when the etiology is unclear, enabling timely management and improved outcomes.