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Sudden death from superior mesenteric artery thrombosis in a cocaine user

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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.

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Authors and Affiliations

  1. Department of Pathology and Laboratory Medicine, The Ottawa Hospital, Ottawa, ON, Canada

    Allison Edgecombe

  2. Eastern Ontario Regional Forensic Pathology Unit, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada

    Christopher Milroy

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  1. Allison Edgecombe
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  2. Christopher Milroy
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Correspondence to Christopher Milroy.

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Edgecombe, A., Milroy, C. Sudden death from superior mesenteric artery thrombosis in a cocaine user. Forensic Sci Med Pathol 8, 48–51 (2012). https://doi.org/10.1007/s12024-011-9248-3

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