Methamphetamine Overdose Causing Ileal Perforation

Methamphetamine abuse is a growing public health issue worldwide, with well-documented effects on the neurological, cardiovascular, and renal systems. However, gastrointestinal complications, particularly intestinal perforation, are rarely reported. We present the case of a 57-year-old male with a long-standing history of methamphetamine use who developed ileal perforation following acute intoxication.This patient ingested a bag of methamphetamines fearing legal consequences. He presented to the emergency department with symptoms including nausea, vomiting, agitation, and diffuse abdominal pain. Laboratory evaluation revealed acute renal injury and significantly elevated creatine kinase, consistent with rhabdomyolysis. Initial imaging demonstrated only gastric dilatation. Over subsequent days, his abdominal symptoms worsened despite conservative management. Follow-up CT imaging demonstrated small bowel pneumatosis and eventually pneumoperitoneum. Exploratory laparotomy revealed ischemia and perforation of the distal ileum, necessitating bowel resection and anastomosis. Histopathology confirmed necrotic bowel tissue.This case highlights the potential for severe gastrointestinal ischemic injury and perforation following methamphetamine ingestion. Clinicians should maintain a high index of suspicion for bowel ischemia in methamphetamine users presenting with abdominal symptoms, even in the absence of initial alarming imaging. Early diagnosis and surgical intervention are essential to avoid fatal complications. This case report discusses a 57-year-old male patient who experienced a rare event of methamphetamine overdose, which led to small bowel perforation six days after using the drug. this upload has Completed CARE Checklist Underlying Data Raw data files from imaging (if anonymized and shareable) Histopathology images (if not already embedded in the manuscript)