Cocaine-associated intestinal gangrene in a pregnant woman

A 31-year-old pregnant woman who was an active cocaine abuser presented to our emergency department five times in 1 week for abdominal pain and vomiting. She continued to use cocaine regularly despite having abdominal pain. Her fifth admission was for seizures. There were no objective signs of peritoneal inflammation and the rectal guiac examination was repeatedly negative. The patient progressed to severe septic shock. Intraabdominal sepsis and/or bowel perforation was suspected. Exploratory laporatomy revealed gangrene and perforation of the small intestine and fecal peritonitis. She rapidly developed multiorgan failure and died. Gastrointestinal complications resulting from cocaine use are uncommon. Our case is unique in that the patient was pregnant, used cocaine by the intranasal route, and lacked objective signs of acute abdomen. Emergency physicians should be aware of the morbidity associated with the use of cocaine.