Acute gastroduodenal perforations associated with use of crack.

Crack, the free-base form of cocaine, was introduced as an illicit street drug in 1986. Since then, we have noted a significant increase in acute gastroduodenal perforations. Between 1982 and 1986, we treated 11 patients with such perforations. This represents a constant occurrence rate of 6% of hospital admissions for peptic ulcer disease. Since 1986 we have treated 16 patients with gastroduodenal perforation, which yields an occurrence rate of 16%. Nine of the 16 patients had a close temporal relationship between the use of crack and the onset of their perforation. This group was younger and disproportionately comprised of male patients. These findings led us to believe that there may be a pathogenic relationship between the use of crack and acute gastroduodenal perforation, and the clinician should be aware of the various potential complications of this new drug. This relationship also raises questions about the exact pathophysiology of peptic ulcer disease.