Hoang M P, Lee E L, Anand A
Department of Pathology, University of Texas Southwestern Medical Center, Dallas, USA.
Am J Surg Pathol. 1998 Nov;22(11):1404-10. doi: 10.1097/00000478-199811000-00011.
Gastrointestinal complications of cocaine abuse occur less frequently than those of the cardiovascular and nervous systems. The clinical history and pathologic findings of three patients with cocaine-induced mesenteric ischemia are described, and the mechanism of acute and chronic cocaine-induced mesenteric ischemia is discussed. The role of preoperative angiography in detecting occlusive arterial lesions so that arterial revascularization can be carried out is emphasized. Briefly, recent intravenous cocaine use in a 45-year-old man resulted in sharply demarcated small intestinal ischemia with perforation characterized by pseudomembranous enteritis. Histologic sections of the small-bowel resection showed intraluminal fibrin and intimal hyperplasia in rare submucosal arterioles. Two women, 29 and 35 years of age, both with a 2-year history of intravenous cocaine use, presented with acute abdominal pain and had angiographic documentation of occlusion of the celiac axis and the superior mesenteric arteries. Vascular bypasses were performed in both cases. Microscopic examination of both arteries and their branches revealed total obstruction by luminal thrombus with recanalization.
可卡因滥用导致的胃肠道并发症比心血管和神经系统并发症的发生频率更低。本文描述了3例可卡因诱发的肠系膜缺血患者的临床病史和病理表现，并探讨了急性和慢性可卡因诱发肠系膜缺血的机制。强调了术前血管造影在检测闭塞性动脉病变以便进行动脉血运重建中的作用。简要介绍如下：一名45岁男性近期静脉使用可卡因后，出现界限清晰的小肠缺血并伴有穿孔，其特征为假膜性肠炎。小肠切除标本的组织学切片显示，罕见的黏膜下小动脉腔内有纤维蛋白和内膜增生。两名女性，分别为29岁和35岁，均有2年静脉使用可卡因的病史，表现为急性腹痛，血管造影显示腹腔干和肠系膜上动脉闭塞。两例均进行了血管搭桥手术。对两条动脉及其分支进行显微镜检查，发现管腔内血栓完全阻塞并伴有再通。
