Can Heroin Poisoning Lead To Stomach Necrosis? A Case Report
International Journal of Medical Toxicology and Forensic Medicine,
Vol. 12 No. 4 (2022),
16 October 2022
,
Page 38932
https://doi.org/10.32598/ijmtfm.v12i4.38932
Abstract
Introduction: Opiate (including heroin) use prevalence is 1.2% of the world population according to the last report of UNOCD. In Iran about 2 million people of population are drug abusers..Heroin reduces gastric motility and prolongs gastric emptying time and it can cause gastric dilation which can be a reason for gastric ischemia . Gastric ischemia is an uncommon condition do to the rich gastric blood perfusion and collateral arteries . As some of studies show, gastric dilation can be a cause for gastric necrosis.
Case presentation: A 22-year-old woman who presented to our hospital with severe abdominal pain and several episodes of vomiting. The patient declared that she had a history of addiction to methamphetamine and heroin. In abdominal examination, a soft and non-distended abdomen with generalized tenderness, mostly in hypogastric region without rebound tenderness was revealed.Abdominal radiograph revealed a much distended stomach. A non-contrast CT abdomen confirmed severe gastric dilatation. On endoscopy, multiple necrotic lesions were seen throughout the stomach and mostly in the proximal part. Our finding in the laparotomy was gastric necrosis in the proximal part, which resulted in a total gastrectomy. esophagojejunostomy with roux en y reconstruction was done after total gastrectomy.
Conclusion: Opioids can increase the risk of GI dysfunction and they can increase risk of infection in GI tract. In our case ,abuse of heroin caused a gastric dilation and massive gastric necrosis.
- Heroin poisoning
- Complication
- Gastric necrosis
How to Cite
References
Sporer KA. Acute heroin overdose. Annals of Internal Medicine. 1999; 130(7):584-90. [DOI:10.7326/0003-4819-130-7-199904060-00019] [PMID]
Demaret I, Lemaître A, Ansseau M. [L'héroïne (French)]. Revue medicale de Liege. 2013; 68(5-6). [Link]
Moradinazar M, Najafi F, Jalilian F, Pasdar Y, Hamzeh B, Shakiba E, et al., Prevalence of drug use, alcohol consumption, cigarette smoking and measure of socioeconomic-related inequalities of drug use among Iranian people: Findings from a national survey. Substance Abuse Treatment, Prevention, and Policy. 2020; 15(1):1-11. [DOI:10.1186/s13011-020-00279-1] [PMID] [PMCID]
Momtazi S, Rawson RA. Substance abuse among Iranian high school students. Current Opinion in Psychiatry. 2010; 23(3):221-6. [DOI:10.1097/YCO.0b013e328338630d] [PMID] [PMCID]
Tas B, Jolley CJ, Kalk NJ, van der Waal R, Bell J, Strang J. Heroin induced respiratory depression and the influence of dose variation: Within subject between session changes following dose reduction. Addiction. 2020; 115(10):1954-9. [DOI:10.1111/add.15014] [PMID]
Baldo BA. Toxicities of opioid analgesics: Respiratory depression, histamine release, hemodynamic changes, hypersensitivity, serotonin toxicity. Archives of Toxicology. 2021; 95(8):2627-42. [DOI:10.1007/s00204-021-03068-2] [PMID]
Yan Y, Chen Y, Zhang X. The effect of opioids on gastrointestinal function in the ICU. Critical Care. 2021; 25(1):1-14. [DOI:10.1186/s13054-021-03793-1] [PMID] [PMCID]
Luncă S, Rikkers A, Stănescu A. Acute massive gastric dilatation: Severe ischemia and gastric necrosis without perforation. Romanian Journal of Gastroenterology. 2005; 14(3):279-83. [PMID]
Popescu R. Total gastrectomy performed in emergency conditions for gastric necrosis due to acute gastric dilatation. Chirurgia (Bucur). 2013; 108(4):576-9. [PMID]
Reichle CW, Smith GM, Gravenstein JS, Macris SG, Beecher HK. Comparative analgesic potency of heroin and morphine in postoperative patients. Journal of Pharmacology and Experimental Therapeutics. 1962; 136(1):43-6. [Link]
Strang J, McDonald R, Campbell G, Degenhardt L, Nielsen S, Ritter A. Take-home naloxone for the emergency interim management of opioid overdose: The public health application of an emergency medicine. Drugs. 2019; 79(13):1395-418. [DOI:10.1007/s40265-019-01154-5] [PMID] [PMCID]
Carnwath T, Smith I. Heroin century. London: Routledge; 2003. [DOI:10.4324/9780203219539]
Dinis-Oliveira RJ. Metabolism and metabolomics of opiates: A long way of forensic implications to unravel. Journal of Forensic and Legal Medicine. 2019; 61:128-40. [DOI:10.1016/j.jflm.2018.12.005] [PMID]
Krätschmer K. Medicinal chemistry as foundation for contraception, birth control, family planning, and fertility. International Journal of Modern Pharmaceutical Research. 2017; 1(1):1-6. [Link]
Lutz PE, Ayranci G, Chu-Sin-Chung P, Matifas A, Koebel P, Filliol D, et al. Distinct Mu, delta, and kappa opioid receptor mechanisms underlie low sociability and depressive-like behaviors during heroin abstinence. Neuropsychopharmacology. 2014; 39(11):2694-705. [DOI:10.1038/npp.2014.126] [PMID] [PMCID]
Hosztafi S. [Heroin, part III: The pharmacology of heroin (Hungarica)]. Acta Pharmaceutica Hungarica. 2003; 73(3):197-205. [PMID]
Briejer MR, Schuurkes JA, Sarna SK. Idiopathic constipation: Too few stools and too little knowledge. Trends in Pharmacological Sciences. 1999; 20(1):1-3. [DOI:10.1016/S0165-6147(98)01278-4]
Huecker MR, Koutsothanasis GA, Abbasy MSU, Marraffa J. Heroin. St. Petersburg: StatPearls Publishing; 2022. [PMID]
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