heroin and Peritonitis

A 35-year-old man stopped breathing after injecting a large dose of heroin. He subsequently received cardiopulmonary resuscitation from friends. He arrived to accident and emergency department with Glasgow Coma Scale of 13. On examination, he had distended and tense abdomen. CT Thorax, Abdomen, and Pelvis confirmed massive tension pneumoperitoneum. A 14 Fr intravenous cannula was inserted through the umbilicus to relieve the intra-abdominal pressure. An emergency laparotomy showed petechia along the anterior gastric wall, haematoma of lesser omentum but showed no evidence of gastrointestinal perforation or organ injury. Air leak test performed by insufflating air into the stomach via nasogastric tube and abdomen filled with normal saline showed no leak. On-table oesophagogastroduodenoscopy showed mild oesophagitis and petechia of cardiac gastric mucosa. He was treated with intravenous antibiotics and discharged on the fifth postoperative day with adequate analgesia.

Topics: Abdominal Cavity; Adult; Analgesia; Anti-Bacterial Agents; Cannula; Cardiopulmonary Resuscitation; Decompression, Surgical; Drug Overdose; Heroin; Humans; Laparotomy; Male; Peritonitis; Pneumoperitoneum; Radiography, Abdominal; Tomography, X-Ray Computed; Treatment Outcome

Topics: Abdomen, Acute; Adult; Anthrax; Bacillus anthracis; Drug Contamination; Fatal Outcome; Heroin; Humans; Male; Peritonitis; Radiography; Substance Abuse, Intravenous; Young Adult

Since the 1980s the abuse of cocaine has been -associated with gastroduodenal perforations in the United States. Here, we report the case of a 28-year-old man who came to our hospital with severe abdominal pain after smoking cocaine. Physical examination revealed generalised abdominal guarding. His X-ray did not show any free intraperitoneal air. However, there was a slightly elevated white blood cell count. Upon laparoscopic exploration of the abdomen, the -patient was found to have a generalised peritonitis secondary to a perforation of the prepyloric anterior wall. The operative procedure consisted of ulcer excision and primary closure with a pyloroplasty as well as an extensive abdominal irrigation after laparotomy.

Topics: Abdomen, Acute; Adult; Cocaine; Cocaine-Related Disorders; Diagnosis, Differential; Heroin; Heroin Dependence; Humans; Laparoscopy; Male; Narcotics; Peptic Ulcer Perforation; Peritonitis; Pylorus; Stomach Ulcer; Vasoconstrictor Agents

Topics: Adolescent; Adult; Aged; Burns; Colon; Endotoxins; Female; Gastrointestinal Hemorrhage; Heroin; Humans; Intestinal Obstruction; Ischemia; Kidney Transplantation; Liver Cirrhosis; Liver Diseases; Lung Diseases, Parasitic; Male; Middle Aged; Mononuclear Phagocyte System; Morphine Dependence; Peritonitis; Sepsis; Shock, Septic; Transplantation, Homologous; Urinary Fistula; Urinary Tract Infections