Document Detail

Perforation of peptic ulcer following abrupt cessation of long-term opiate use.
MedLine Citation:
PMID:  20740346     Owner:  NLM     Status:  MEDLINE    
PURPOSE: Unaided and abrupt cessation of opiate use without drug substitution and step-down, referred to as "cold turkey," is a common and difficult process for substance users, and is associated with several withdrawal symptoms and complications. This report presents a preliminary series of patients treated at an urban public hospital with acute perforation of peptic ulcers following abrupt cessation of long-term opiate use, a phenomenon that has not been previously described in the literature.
METHODS: Thirty-five patients with acute gastroduodenal perforation and a history of opiate addiction with a recent and abrupt cessation of opiate use were admitted between February 2004 and October 2008. This study evaluated the demographics, antecedent drug use, substance use characteristics, previous medical or surgical treatment of peptic ulcer disease, and surgical findings.
RESULTS: The mean age was 32.3 years (range, 21-41 years) and the patients were overwhelmingly male (94%). The most frequent agent in single opiate users was opium (62.9%) followed by heroin (22.9%). The time interval between opiate cessation and perforation onset was 2-65 days (mean, 6.1 days). All patients underwent an immediate exploratory laparotomy, and the majority of perforations were found to be in the postpyloric area (94%) with mean size of 4.3 x 5.1 mm. Two patients (6%) had perforations in the lesser curvature of the stomach.
CONCLUSION: All of the perforations occurred following sudden self-cessation without step-down or classic maintenance therapy, and this may prove the importance of supervised medical detoxification with special attention to gastroprotective agents such as antacid drugs.
Mahdi Kahrom; Hadi Kahrom
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Publication Detail:
Type:  Journal Article     Date:  2010-08-26
Journal Detail:
Title:  Surgery today     Volume:  40     ISSN:  1436-2813     ISO Abbreviation:  Surg. Today     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-08-26     Completed Date:  2011-01-19     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9204360     Medline TA:  Surg Today     Country:  Japan    
Other Details:
Languages:  eng     Pagination:  836-9     Citation Subset:  IM    
Department of General Surgery, Mashhad University of Medical Sciences, Mashhad 91959-77178, Iran.
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MeSH Terms
Opioid-Related Disorders / complications*
Peptic Ulcer Perforation / diagnosis,  etiology*,  physiopathology
Substance Withdrawal Syndrome* / diagnosis
Young Adult

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