Sudden Death From Massive Gastrointestinal Hemorrhage Associated With Crack Cocaine Use

Abstract

Cocaine is associated with many health complications including gastrointestinal ischemia/infarction, and hemorrhage. The clinical medical literature describes such entities, but no case exists within the forensic literature describing life-threatening intraluminal gastrointestinal hemorrhage and sudden death associated with cocaine. A 48-year-old black man died suddenly in his home, with drug paraphernalia near the body. Further investigation revealed blood stains on upholstery, and a toilet filled with fresh blood. External examination of the body revealed fresh blood draining from the anus. Internal examination revealed a dusky portion of distal ileum filled with an abundance of fresh blood. Toxicology confirmed the suspicion of acute cocaine intoxication.Review of the clinical literature revealed several case reports describing an association between cocaine use and intestinal infarction, one with hemoperitoneum. Review of the forensic literature returned one case describing an association between cocaine toxicity and intestinal infarction, but without hemorrhage. To our knowledge, our case represents the first report in the forensic literature describing massive gastrointestinal hemorrhage associated with acute cocaine intoxication. It is important that the forensic pathologist recognize cocaine toxicity as a potential cause of gastrointestinal bleeding, especially in younger male decedents without significant comorbidities. Scene investigation may reveal useful clues pointing to this unusual etiology.

Iatrogenic pathology of the intestines

“…Ischaemic‐pattern colitis has been reported in association with a variety of drugs, including oral contraceptives, ergotamine derivatives, cocaine and, potentially, sumatriptan [a serotonin‐1 5‐hydroxytryptamine (5‐HT 1) receptor agonist] overuse . Rare cases of ischaemic colitis associated with interferon‐alpha (IFN‐α) treatment for chronic hepatitis C (HCV) infection and metastatic cancer have been reported .…”

Cocaine Intoxication-Clinical Findings from 402 Acute Deaths

“…Similar report of cocaine associated GIT bleeding have been documented in past (23,24). It is suggested that massive GIT bleeding could contribute to high mortality rate seen in drug packers with ruptured contents (25,26) A wide range of pathological effects were seen in CNS during autopsy that ranged from intracerebral haemorrhages to ischaemic changes (encaphalomalacia). This is in agreement with the findings of Schreiber et al, (11).…”

A rare cause of acute respiratory failure: spontaneous pneumomediastinum due to cocaine use

“…Other complications that have been described include subarachnoid hemorrhage, obstetric complications, sexual dysfunction, and a variety of psychiatric disorders. [7] Rapid diagnosis of pneumomediastinum is important because it is a potentially lethal condition. Serious complications such as tension and bilateral pneumothorax as well as tension pneumomediastinum, which causes cardiac compression and reduces cardiac output, have also been reported.…”