Breaking the Bowel - A Subacute Ischemic Complication of Chronic Methamphetamine Use

Sep 28, 2026

Methamphetamine is a powerful sympathomimetic drug, but its gastrointestinal complications—especially ischemic bowel disease—are insufficiently recognized in emergency medicine. A 34-year-old man with chronic methamphetamine use presented for medical clearance for rehabilitation with three days of mild diffuse abdominal pain. Imaging and labs showed ischemic features including pneumoperitoneum and mesenteric stranding, leading to emergent laparotomy, bowel resection, postoperative intensive care for sepsis, and eventual recovery after 15 days.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages5

Reading Time13 min

AccessFree to download

Abstract

Introduction

Case Presentation

Received 09/17/2025 Review began 09/24/2025 Review ended 11/29/2025 Published 12/02/2025 © Copyright 2025 Moran et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited. DOI: 10.7759/cureus.98331 Open Access Case Report Published via University of Florida College of Medicine – Jacksonville Breaking the Bowel: A Subacute Ischemic Complication of Chronic Methamphetamine Use Benjamin Moran 1, Tiffany Scotto 2, Sophia Sheikh 1 1. Emergency Medicine, University of Florida College of Medicine – Jacksonville, Jacksonville, USA 2. Internal Medicine, University of Florida College of Medicine – Jacksonville, Jacksonville, USA Corresponding author: Benjamin Moran, [benjamin.moran@jax.ufl.edu](benjamin.moran@jax.ufl.edu) Abstract Methamphetamine is a potent sympathomimetic agent primarily associated with cardiovascular and neuropsychiatric effects. However, its gastrointestinal complications, particularly ischemic bowel disease, are under-recognized in emergency medicine literature. A 34-year-old man with a history of chronic methamphetamine use presented to the emergency department (ED) seeking medical clearance for rehabilitation admission. He also reported mild, diffuse abdominal pain persisting for three days. Vital signs revealed tachycardia and hypotension. Physical examination showed mild subjective diffuse abdominal tenderness without peritoneal signs. Laboratory studies indicated leukocytosis, elevated lactate, and acute kidney injury. Non-contrast abdominal and pelvic computed tomography (CT) demonstrated pneumoperitoneum and extensive mesenteric stranding consistent with ischemia. The patient was managed with intravenous fluids, broad-spectrum antibiotics, and emergent surgical consultation. Exploratory laparotomy revealed hemoperitoneum, a large abscess cavity, necrosis of the cecum, and mesenteric ischemia. A resection of the cecum and terminal ileum was performed. Postoperatively, the patient required intensive care management for septic shock and renal failure but eventually recovered and was discharged after 15 days. This case underscores the importance of considering chronic methamphetamine use as a potential etiology for gastrointestinal ischemia and sepsis, even in patients presenting with subtle abdominal complaints. Early recognition and intervention are crucial for improving outcomes in this high-risk population. Categories: General Surgery, Emergency Medicine, Substance Use and Addiction Keywords: abdominal abscess, bowel ischemia, emergency exploratory laparotomy, fluid resuscitation, mesenteric ischemia, methamphetamine, necrotic bowel, sepsis, substance use disorder, toxicology Introduction The most common side effects and complications of methamphetamine use include acute symptoms such as chest pain, palpitations, hypertension, hyperthermia, impulsivity, psychosis, and delirium [1] . However, its impact on the gastrointestinal system, particularly in causing ischemic bowel disease, remains underappreciated in emergency medicine literature compared to other stimulants such as cocaine [2-4]. Thevasoconstrictive properties of methamphetamine can lead to mesenteric ischemia, a condition that, if not promptly diagnosed and treated, carries a high mortality rate [5] . Mesenteric ischemia, bowel obstruction, and sepsis can evolve insidiously in the context of chronic methamphetamine use, often leading to delayed diagnosis and poor outcomes. Emergency physicians are uniquely positioned to identify these presentations early, especially in patients who may not initially appear acutely ill. This report highlights an unusual case of subacute non-occlusive ischemic bowel disease from chronic methamphetamine use. Additionally, this case also aims to raise awareness of chronic methamphetam

FAQs

What gastrointestinal complication is highlighted in the report?

The report emphasizes ischemic bowel disease, specifically a subacute non-occlusive ischemic complication linked to chronic methamphetamine use.

What initial symptoms did the patient report?

He reported mild, diffuse abdominal pain persisting for three days and sought medical clearance for rehabilitation admission.

How was the patient diagnosed and treated?

CT findings showed pneumoperitoneum and extensive mesenteric stranding consistent with ischemia; management included fluids, broad-spectrum antibiotics, emergent surgical consultation, and exploratory laparotomy with cecum and terminal ileum resection.

Sep 28, 2026

Uploaded by LangkahRina