title: Sudden death from superior mesenteric artery thrombosis in a cocaine user.
abstract: Cocaine-mediated tissue injury is well established, particularly myocardial ischemia and infarction. Gastrointestinal complications including mesenteric ischemia, ischemic colitis and intestinal perforation occur less frequently. Cocaine-induced visceral arterial thrombosis is a rare finding. We report a case of a 49-year-old chronic cocaine user with superior mesenteric artery (SMA) thrombosis. The patient presented with a 24-h history of abdominal pain, nausea and vomiting. Physical examination documented tachycardia and a soft, non-rigid abdomen with voluntary guarding. Abdominal X-ray did not show any evidence of peritoneal free air or bowel obstruction. Laboratory investigations revealed elevated white blood cells and a high anion gap; a blood gas analysis was not done. Three hours after initial presentation, the patient had a cardiac arrest and died. At autopsy, the jejunum was ischemic, without obvious infarction. The SMA was occluded at its origin by significant atherosclerosis with superimposed thrombus. The myocardium had fibrosis, without acute infarction, and severe triple coronary artery atherosclerosis. Toxicological blood analysis confirmed cocaine use. This report emphasizes the need to consider chronic stimulant drug abuse in accelerated atheroma and thrombosis of visceral arteries.
authors: Department of Pathology and Laboratory Medicine, The Ottawa Hospital, Ottawa, ON, Canada.
authors: Allison
authors: A
authors: Edgecombe
authors: Christopher
authors: C
authors: Milroy
references: Ann Vasc Surg. 1998 Sep;12(5):476-81
references: 9732428
references: Vasa. 2006 May;35(2):106-11
references: 16796010
references: J Vasc Surg. 2004 Aug;40(2):291-5
references: 15297823
references: Am J Gastroenterol. 1997 Jun;92(6):1053-4
references: 9177533
references: Am J Emerg Med. 2001 Jan;19(1):61-3
references: 11146022
references: Ann Intern Med. 1990 Nov 1;113(9):715-6
references: 2221653
references: J Forensic Sci. 1990 May;35(3):740-5
references: 2348187
references: Heart. 2000 Jun;83(6):688-95
references: 10814631
references: Pharmacol Res. 2009 Nov;60(5):361-8
references: 19559087
references: J Vasc Surg. 1996 Apr;23(4):724-9
references: 8627913
references: Eur Heart J. 2010 Feb;31(3):318-29
references: 20071326
references: Am J Cardiol. 1993 Jul 15;72(2):243-6
references: 8328397
references: Am J Surg Pathol. 1998 Nov;22(11):1404-10
references: 9808133
references: Am J Gastroenterol. 1994 Sep;89(9):1558-61
references: 8079939
references: Am J Cardiol. 2002 May 1;89(9):1133-5
references: 11988210
references: J Am Coll Cardiol. 1991 Jun;17(7):1553-60
references: 2033185
references: Langenbecks Arch Surg. 2008 Mar;393(2):163-71
references: 18172675
references: Circulation. 1993 Sep;88(3):876-83
references: 7689042
references: J Vasc Surg. 1996 Apr;23(4):719-23
references: 8627912
references: Cardiovasc Toxicol. 2008 Dec;8(4):161-71
references: 18813882
references: Ann Vasc Surg. 1999 May;13(3):302-4
references: 10347264
references: Am J Cardiol. 1990 Feb 1;65(5):303-8
references: 2301258
references: J Toxicol Clin Toxicol. 1996;34(6):673-84
references: 8941196
references: J Clin Gastroenterol. 1997 Jan;24(1):49-53
references: 9013352
references: N Engl J Med. 2001 Aug 2;345(5):351-8
references: 11484693
references: South Med J. 2000 Sep;93(9):909-13
references: 11005354
references: Dig Dis Sci. 1998 Mar;43(3):586-9
references: 9539655
references: Arch Surg. 1988 Mar;123(3):394
references: 3341919
references: AJR Am J Roentgenol. 1992 Jul;159(1):73-5
references: 1609725
references: N Engl J Med. 1989 Dec 7;321(23):1557-62
references: 2573838
references: Addiction. 2006 Dec;101(12):1771-7
references: 17156176
references: Ital J Gastroenterol Hepatol. 1999 May;31(4):305-7
references: 10425576
references: N Engl J Med. 1989 Dec 7;321(23):1604-6
references: 2586556
references: Am J Cardiovasc Drugs. 2009;9(3):177-96
references: 19463023
references: Surgery. 1985 Mar;97(3):374-6
references: 3871976
references: West J Med. 1999 Jan;170(1):47-9
references: 9926736