Massive portal venous air and pneumatosis intestinalis associated with cocaine-induced mesenteric ischemia.

ABSTRACT

BACKGROUND: We report a 53-year-old female who presented to the emergency department in distress with an acute abdomen after recreational use of cocaine. DISCUSSION: The patient's computed tomography scan revealed extensive portal venous air with small-bowel pneumatosis intestinalis resulting from intestinal ischemia. Air could be seen throughout the superior mesenteric vein, portal vein, and hepatic portal venous distribution. The patient underwent extensive resuscitation and resection of small bowel requiring three operative interventions. A pertinent review of the literature of cocaine-induced small-bowel ischemia is provided covering the pathophysiology, clinical findings, and epidemiology. CONCLUSION: Cocaine-induced mesenteric ischemia is a serious disease causing significant morbidity and mortality. Operative therapy is often required.