Crack cocaine-related prepyloric perforation treated laparoscopically

Abstract

Perforation, which occurs in seven to 10 patients per 100,000 population annually, complicates 5-10% of peptic ulcers. Crack cocaine has been associated with many gastrointestinal disorders, including ulcer perforation. Crack-related gastroduodenal perforations, typically prepyloric, have been on the rise in the last decade. Suggested mechanisms include ischemia, motility disorders, increased air swallowing, platelet-related thrombosis, and increased ACTH and corticosterone secretion. A 28-year-old man presented with vomiting and sudden generalized abdominal pain 3 h after smoking a "rock" (a 100-mg cube of crack). Physical examination revealed generalized guarding, and plain films showed free intraperitoneal air. Laparoscopy confirmed the diagnosis of generalized peritonitis secondary to a 5-mm perforation of the prepyloric anterior wall of the gastric antrum. Omentum-patched primary closure and thorough abdominal irrigation were undertaken. The postoperative course was uneventful. Omeprazole and anti-H. pylori treatment, including erythromycin and metronidazole, were maintained for 8 weeks and 1 week, respectively. Although drug addicts are not easily compliant with long-term medical treatment, in the particular case of crack addiction, the vasoconstrictive and dismotility effects of cocaine may precipitate gastric necrosis and paralysis, respectively, in the case of vagotomy. Although distal gastrectomy was the wisest choice when open ulcer surgery was adopted, the laparoscopic treatment of perforated ulcer, with either suture or sutureless techniques, has been found to be comparable to open surgery with regard to postoperative morbidity, reoperation rates, and mortality. The potential advantages of laparoscopy include the avoidance of large incisions, less attendant pulmonary morbidity, less wound infection, and possibly fewer postoperative adhesions.

Crack Cocaine Comsuption as a Main Risk Factor in Pacients With Perforated Peptic Ulcer

“…En los artículos internacionales se reporta una prevalencia del 20% con el mismo factor de riesgo y siendo predominante el sexo masculino. 9,11. El promedio de edad encontrado es de 27 años en los pacientes consumidores de crack en nuestra serie, mientras que hallazgos reportados en la literatura reportan edades entre 27 y 34 años 9,10,12 .…”

“…En todos los casos la conducta quirúrgica fue reavivamiento de bordes de la ulcera, rafia primaria y parche de epiplón. Tanto la ubicación de la perforación comoLa conducta quirúrgica descripta en diferentes artículos coinciden con los resultados obtenidos en este reporte 9,10,12,13 El tamaño de las ulceras en los casos registrados en este trabajo en consumidores de crack es menor o igual a 5mm de diámetro y como hallazgo intraoperatorio una extensa contaminación peritoneal. Artículos relacionados reportan ulceras de hasta 5mm en pacientes con las mismas características, con contaminación peritoneal extensa y signos de peritonitis aguda generalizada 9,12,13 CONCLUSIÓN Los pacientes consumidores de crack con ulcera péptica perforada en la IICCQx del Hospital de Clínicas durante el periodo 2011-2016 corresponden a un grupo de pacientes adultos jóvenes de sexo masculino, procedentes de la capital y ciudades contiguas a la misma, con clínica de peritonitis aguda generalizada.…”

Atypical Gastric Ulcer With Impending Perforation due to Cocaine Use

“…The knowledge on the endoscopic appearance of cocaine-induced gastric ulcers is limited, mainly because of the presentation of patients with frank perforations. 1 Most common locations of these are in the greater curvature, prepyloric/pyloric regions and the first portion of the duodenum. 2 The presentation of our patient with the endoscopic appearance of cocaine-associated ulcer located at the incisura is unusual.…”

Kokain-assoziierte Magenperforation

“…Insbesondere das Rauchen des sogenannten "Crack"-Kokains, einer Kokain-Base die aus Kokain-Hydrochlorid durch Erhitzen mit einer Lauge wie Natriumbikarbonat oder Ammoniak hergestellt wird, scheint neben intestinalen Ischämien auch zahlreiche Perforation des Magens, typischerweise präpylorisch, in den letzten beiden Jahrzehnten in den USA verschuldet zu haben [8][9][10] [11]. Weitere Mechanismen wie Kokain-induzierte Motilitätsstörung, erhöhte Sekretion von ACTH und Kortikosteroiden sowie Störung der Mukosaintegrität und der Synthese-Balance zwischen dem mukosalen, vasodilatatorischen Prostaglandin E 2 (PGE 2 ) und dem vasokonstriktorischen Leukotrien C 4 (LTC 4 ) wurden ebenfalls diskutiert [12,13]. Kokain ist nach Cannabis die weltweit am häufigsten gehandelte Droge.…”

“…Demgemäß scheint ein "säurereduzierendes" Vorgehen bei der operativen Versorgung empfehlenswert zu sein. Daneben wird im Falle einer geringen peritonealen Kontamination auch ein laparoskopisches Vorgehen empfohlen [12,17]. In dem vorgestellten Fall jedoch sahen wir aufgrund der ausgeprägten Peritonitis die Indikation für eine Laparotomie gegeben.…”