High mortality of cocaine-related ischemic colitis: a hybrid cohort/case-control study

Abstract

Background: Isolated case reports describe bowel ischemia in cocaine users, and the optimal management of these patients remains uncertain.

Design: Case-control study.

Setting: Teaching hospitals.

Patients: Patients hospitalized for colonic ischemia related to cocaine compared with noncocaine-related ischemic colitis. Cases were identified by using ICD-9 codes and laboratory urine toxicology tests. Patients were included if they had a confirmed diagnosis of bowel ischemia by CT, colonoscopy, angiography, or, in the case of emergency exploration, a pathology report showing bowel ischemia and a urine toxicology test that was positive for cocaine. Controls were individuals who met the same criteria but had no history of cocaine use and a urine test negative for cocaine. Charts were individually audited for accuracy of coding.

Main outcome measurements: Mortality and its risk factors.

Results: Patients with cocaine-related ischemia were significantly younger and had a significantly (P < .05) higher mortality rate than patients with ischemic colitis unrelated to cocaine (cocaine: 5/19 [26%] and noncocaine: 6/78 [7.7%]). The cause of death in all cases was septic shock caused by extensive bowel ischemia. Multivariate logistic regression analysis showed that cocaine-related ischemic colitis was a significant risk factor for mortality (odds ratio 5.77; 95% CI, 1.37-24.39) as was the need for surgical intervention (odds ratio 4.95; 95% CI, 1.22-20.12).

Limitations: Retrospective design.

Conclusions: Cocaine-related ischemic colitis has a high mortality. In young patients presenting with acute abdominal pain and/or rectal bleeding with evidence of bowel wall thickening or pneumatosis on imaging studies or colonoscopy, cocaine-related ischemia should be considered. Testing for cocaine use may help identify patients at high risk of sepsis and death.