​​Breaking the Bowel: A Subacute Ischemic Complication of Chronic Methamphetamine Use

Methamphetamine is a potent sympathomimetic agent primarily associated with cardiovascular and neuropsychiatric effects. However, its gastrointestinal complications, particularly ischemic bowel disease, are under-recognized in emergency medicine literature. A 34-year-old man with a history of chronic methamphetamine use presented to the emergency department (ED) seeking medical clearance for rehabilitation admission. He also reported mild, diffuse abdominal pain persisting for three days. Vital signs revealed tachycardia and hypotension. Physical examination showed mild subjective diffuse abdominal tenderness without peritoneal signs. Laboratory studies indicated leukocytosis, elevated lactate, and acute kidney injury. Non-contrast abdominal and pelvic computed tomography (CT) demonstrated pneumoperitoneum and extensive mesenteric stranding consistent with ischemia. The patient was managed with intravenous fluids, broad-spectrum antibiotics, and emergent surgical consultation. Exploratory laparotomy revealed hemoperitoneum, a large abscess cavity, necrosis of the cecum, and mesenteric ischemia. A resection of the cecum and terminal ileum was performed. Postoperatively, the patient required intensive care management for septic shock and renal failure but eventually recovered and was discharged after 15 days. This case underscores the importance of considering chronic methamphetamine use as a potential etiology for gastrointestinal ischemia and sepsis, even in patients presenting with subtle abdominal complaints. Early recognition and intervention are crucial for improving outcomes in this high-risk population.