Title: Cocaine-Induced Abdominal Pain
题目：可卡因引起的腹痛
Author 作者: Haney Mallemat

• The well-known effects of cocaine toxicity include seizures, cardiac ischemia, and rhabdomyolysis. Abdominal pain, however, is a lesser known side-effect and may occur secondary to ischemia, infarction or perforation of the gastrointestinal tract; such cases tend to occur in younger people without known risk factors for ischemia.
• 可卡因的毒性效应是众所周知的，包括癫痫发作，心肌缺血，和横纹肌溶解。而腹痛是一个不太为人知的副作用，其出现可能是由于继发的胃肠道缺血，梗塞或穿孔。这种情况下通常会发生在没有缺血危险因素的年轻人。
• Ischemia may occur from the direct vasoconstrictive effects of cocaine, but may also occur from its pro-thrombotic effects on the mesenteric vessels; although any segment of the GI tract may be involved, the small bowel is most often affected.
• 缺血可能与可卡因的直接血管收缩作用有关，但也可以从它的肠系膜血管促血栓形成效应引起，虽然可能涉及胃肠道的任何部分，小肠是最常见的受累部位。
• Symptoms may vary from mild abdominal pain to bloody diarrhea. Physical exam may reveal peritoneal signs if perforation occurs.
• 症状可从轻微腹痛到血性腹泻。如果发生穿孔，体检时可有腹膜炎征。
• CT scan of the abdomen may reveal the diagnosis although angiography may required for diagnosis or to guide revascularization.
• 腹部CT扫描可确诊，但偶尔需要血管造影来确定诊断或指导血管重建。
• Management may vary from conservative (i.e., bowel rest and antibiotics) to surgical exploration and bowel resection in selected cases.
• 治疗可以从保守（即肠道休息和抗生素）到某些病例的手术探查和肠道切除。

References参考文献：
Zimmerman, J.Cocaine intoxication.Crit Care Clinics 2012 Oct;28(4):517-526