Abstract
Cocaine or Benzoylmethylecgonine is an alkaloid extracted from the leaves of the Erythroxylon plant, which can cause gastrointestinal ischemia from severe arterial vasoconstriction via stimulation of alpha-adrenergic receptors in the gastric and mesenteric arteries. We report this case of a 65-year-old man who presented with a single massive ulcer at the incisura of the stomach as a result of cocaine use. The size and location of this ulcer were atypical and illustrate the potential for serious gastrointestinal manifestations from cocaine use.
Highlights
Recent estimates suggest that cocaine use is still rampant with almost 1.9% of population of North America indulging in it, the rate being highest in the world [1]
Ulcer site histology revealed inflamed granulation type tissue with focal eosinophilic infiltrates. Both histology and rapid urease test (RUT) were negative for Helicobacter pylori
Cocaine has been implicated in direct vasculotoxicity by increasing endothelial permeability to low-density lipoprotein (LDL) causing regulated expression of endothelial adhesion molecules [10] which subsequently leads to leukocyte migration and proliferation of adventitial mast cells [11]
Summary
Recent estimates suggest that cocaine use is still rampant with almost 1.9% of population of North America indulging in it, the rate being highest in the world [1]. Cocaine has a very short plasma half-life (0.5 to 1.5 hours) but extended tissue half-life of up to 8 hours [2]. Cocaine has multisystem manifestation with well-recognized gastrointestinal manifestations ranging from gastroduodenal ulceration with perforation [4,5,6,7,8] to intestinal infarction with perforation [9]. Cocaine-associated gastroduodenal ulcers are frequently distributed in the greater curvature, prepyloric and pyloric canal regions of the stomach along with the first portion of the duodenum. We intend to report a rare instance of a cocaine-induced giant ulcer at the gastric incisura
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