Cocaine-induced ischemic colitis with small-vessel thrombosis of colon and gallbladder

Ischemic colitis is a rare complication of cocaine abuse. To date, only 15 reports have linked the use of cocaine to ischemic events of the small bowel and colon. We report ischemic colitis in a 36-year-old woman who admitted using crack cocaine twice, 1 and 2 days before onset of symptoms. Patchy areas of necrosis were grossly present in the resected transverse colon. In addition, the gallbladder showed edema and congestion of the wall on gross examination. On microscopy, the gallbladder as well as the colon were noted to have multiple small-vessel thrombi. Colonic mucosa showed ischemic necrosis. Cocaine abuse should be considered in the differential diagnosis of ischemic colitis, especially in a young adult.