Colonic perforation: A lethal consequence of cannabis body packing

Cawich, Shamir O; Downes, Ross O.; Martin, A.; Evans, Necia R.; Mitchell, D. I. G.; Williams, Eric H.

doi:10.1016/j.jflm.2010.02.012

Cited by 22 publications

(11 citation statements)

References 25 publications

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“…They may choke directly on a package being swallowed, especially if intoxicated, or the swallowed packages burst. In these situations they typically have very high concentrations of drugs [364][365][366][367] sufficiently to cause perforation of the bowel.…”

Section: Gastrointestinal Toxicity and Cocainementioning

confidence: 99%

Side Effects of Cocaine Abuse: Multiorgan Toxicity and Pathological Consequences

Riezzo

Fiore²,

Carlo³

et al. 2012

CMC

176

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Cocaine is a powerful stimulant of the sympathetic nervous system by inhibiting catecholamine reuptake, stimulating central sympathetic outflow, and increasing the sensitivity of adrenergic nerve endings to norepinephrine (NE). It is known, from numerous studies, that cocaine causes irreversible structural changes on the brain, heart, lung and other organs such as liver and kidney and there are many mechanisms involved in the genesis of these damages. Some effects are determined by the overstimulation of the adrenergic system. Most of the direct toxic effects are mediated by oxidative stress and by mitochondrial dysfunction produced during the metabolism of noradrenaline or during the metabolism of norcocaina, as in cocaine-induced hepathotoxicity. Cocaine is responsible for the coronary arteries vasoconstriction, atherosclerotic phenomena and thrombus formation. In this way, cocaine favors the myocardial infarction. While the arrhythmogenic effect of cocaine is mediated by the action on potassium channel (blocking), calcium channels (enhances the function) and inhibiting the flow of sodium during depolarization. Moreover chronic cocaine use is associated with myocarditis, ventricular hypertrophy, dilated cardiomyopathy and heart failure. A variety of respiratory problems temporally associated with crack inhalation have been reported. Cocaine may cause changes in the respiratory tract as a result of its pharmacologic effects exerted either locally or systemically, its method of administration (smoking, sniffing, injecting), or its alteration of central nervous system neuroregulation of pulmonary function. Renal failure resulting from cocaine abuse has been also well documented. A lot of studies demonstrated a high incidence of congenital cardiovascular and brain malformations in offspring born to mothers with a history of cocaine abuse.

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Section: Gastrointestinal Toxicity and Cocainementioning

confidence: 99%

Side Effects of Cocaine Abuse: Multiorgan Toxicity and Pathological Consequences

Riezzo

Fiore²,

Carlo³

et al. 2012

CMC

176

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“…In these situations they typically have very high concentrations of drugs 96–98 . The packages may also cause perforation of the bowel 99 . Gastric ulceration has been reported in a body packer 100 .…”

Section: Gastrointestinal Tractmentioning

confidence: 99%

“…[96][97][98] The packages may also cause perforation of the bowel. 99 Gastric ulceration has been reported in a Figure 11. Intra-alveolar brown pigmented macrophages in a cannabis user.…”

Section: Respiratory Systemmentioning

confidence: 99%

The histopathology of drugs of abuse

Milroy

Parai

2011

Histopathology

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The use of drugs for recreational purposes is widespread. The drugs used can be divided into groups including stimulants (cocaine, amphetamines, etc.), opiates and opioids (heroin, oxycodone, methadone, fentanyl, etc.), sedatives (benzodiazepines and related substances) and miscellaneous drugs, including ketamine and cannabis (marijuana). These drugs can have profound effects on all organ systems in the body. The method of administration, whether by injection or inhalation, can cause localized and systemic effects, including the transmission of infection and granulomata at the site of injection and in the lungs. Suppurative abscesses from injection can result in systemic amyloidosis. Stimulants have profound effects on the cardiovascular and cerebrovascular systems, with enlarged hearts with fibrosis seen microscopically and cerebral infarction and haemorrhage. Crack cocaine use is also associated with changes in the pulmonary system, including carbon pigmented intra-alveolar macrophages, emphysema and pulmonary arterial changes. Cannabis use is associated with brown pigmented macrophages in the lung as well as changes in the respiratory tract epithelium. Opiates/opioids are associated with inhalational pneumonitis and hypoxic brain damage due to their respiratory depressant effects. Heroin use has been associated with focal segmental glomerulonephritis (heroin-associated nephropathy: HAN). 3,4-Methylenedioxymethamphetamine (MDMA; ecstasy) use is associated with changes in the cardiovascular system. Its use can lead to hyperpyrexia, which results in systemic changes. Ketamine abuse has been associated with cystitis. Drugs of abuse may affect testicular function. In analysing the effects of drugs at autopsy a systematic approach to sampling of histology is required.

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“…In fact, in medical literature, there have been some reported cases of mortality in body packers due to esophageal and bowel perforation, [19][20][21] gastrointestinal (GI) ulceration, 22 and obstruction or acute drug toxicity during internal transportation of heroin, 19 cocaine, or cannabis. [23][24][25] In the radiological report, it is also essential to specify the exact location of the packages in case of emergency surgical treatment reserved for the life-threatening complications of drug-packet ingestion. 26 Enterotomy is necessary to evacuate packages in the small bowel, distal to the ligament of Treitz, whereas packages in the stomach and duodenum should be evacuated through separate incision-gastrotomy with possible help of endoscopy for packages in duodenum.…”

Section: Introductionmentioning

confidence: 99%

“…40,42 However, many times, the radiological opacity of a drug depends on the composition with other substances or its grade of purity and often it is strongly correlated to the grade of its compression, the substance form (eg, a compressed powder or paste or a crystallized substance), and the manufacturing process and coating. [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] Typically, on plain abdominal radiographs, drug materials appear as multiple uniformly spherical or oval-shaped foreign bodies of similar density to feces, while the wrapping materials can be of higher density, allowing more accurate visualization (Fig. 5).…”

Section: Introductionmentioning

confidence: 99%