Enterocolitis Associated With Cocaine Use

Cocaine use has been reported to cause gastrointestinal complications. This retrospective review describes the presentation and clinical course of cocaine-associated enterocolitis.

Charts with a diagnoses of colitis or abdominal pain, between 1991 to 2001, were reviewed for a positive urine drug screen or documented cocaine use. Data about the patients' symptoms and physical findings, results of clinical studies, and outcome were collected.

There were 18 patients identified. The interval from last use to the onset of pain was fewer than one day for seven patients, one to three days for seven patients, and more than three days for four patients. Physical examination demonstrated diffuse peritonitis in 2 patients, tenderness localized to a single quadrant in 11 patients, and tenderness in two or more quadrants in 5 patients. Computed tomography was obtained in 11 patients with 10 demonstrating signs of inflammation or ischemia. The anatomic locations of disease were proximal colon (14 patients), small bowel/gastric (1 patient), and distal colon (3 patients). The initial management was nonoperative in 15 patients. One patient presented in shock and died. Another developed peritonitis and underwent laparotomy. Surgical intervention occurred in four patients (3 initially, 1 on Day 4) for peritonitis. Two died postoperatively, a 50-percent surgical mortality.

Cocaine-associated enterocolitis usually presents within three days of cocaine use. Inflammatory or ischemic changes are most common in the proximal colon. The majority of patients will recover with nonoperative therapy; however, those who develop peritonitis and undergo laparotomy have a 50 percent mortality.