The Epidemic of Cocaine-Related Juxtapyloric Perforations: With a Comment on the Importance of Testing for Helicobacter pylori

In 1996, an estimated 1.7 million persons in the United States used cocaine (benzoylmethylecgonine or C17H21NO4) at least once a month. 1 Approximately 40% of these addicts used “crack” cocaine (cocaine base), a street product made by mixing cocaine hydrochloride (powder or crystalline cocaine) with alkali in boiling water. Crack cocaine has been available for illicit use for approximately 12 years in the United States. Although the numerous adverse effects of using cocaine hydrochloride intranasally (“snorting”) or intravenously are well known, 2–11 only a few reports have documented the complication of gastroduodenal perforation after the smoking of crack cocaine in glass pipes or cigarettes. 12–16 This is a report of the recent experience with cocaine-related juxtapyloric gastrointestinal perforations at Grady Memorial Hospital in Atlanta, Georgia.