SPECTRUM OF ISCHEMIC COLITIS IN COCAINE USERS

Ischemic enterocolitis is a well-recognized entity occurring in cocain e users. Diagnosis is based on the presence of rectal bleeding, abdomi nal pain, a history of cocaine use; supportive endoscopic and histopat hologic findings, and the absence of other etiologic mechanisms of isc hemic colitis. In this study, we evaluated endoscopic and histopatholo gic findings in seven patients with cocaine colitis. Lesions seen by e ndoscopy, which were restricted to the left colon, included hemorrhagi c edematous mucosa, pseudopolyps, and ulcerations. Rectal involvement, not a common feature of ischemic colitis, was seen in five patients. In two patients histologic lesions were classified acute/subacute, and in three patients as subacute/chronic. In the remaining two patients lesions were combined acute/subacute and chronic. The presence of suba cute/chronic lesions suggested recurrent ischemic episodes and could r eflect repeated use of cocaine. Future studies will be needed to defin e the long-term clinical and histopathologic significance of these sub acute/chronic lesions.