Situations where encountered:
(1) abuse of cocaine, often crack cocaine
(2) abuse of amphetamines, usually methamphetamine
(3) therapeutic use of dextroamphetamines for ADHD, obesity or narcolepsy
(4) use of nasal decongestants containing a sympathomimetic agent
Clinical features:
(1) episodes of transient ischemic colitis in a relatively young person
(2) clinical evidence of drug misuse or a prescription for vasoconstricting drug
(3) laboratory evidence of exposure to a vasoconstricting agent. Hair testing can be valuable if urine testing is negative and the patient denies drug use.
(4) colon biopsy compatible with ischemic colitis
(5) no other explanation identified after a complete workup
Signs and symptoms of ischemic colitis:
(1) abdominal pain
(2) unexplained diarrhea
(3) lower gastrointestinal tract bleeding
(4) dusky mucosal edema with or without ulcerations
Complications:
(1) bowel perforation
(2) peritonitis
(3) stricture
(4) chronic blood loss with anemia
