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It is well recognized that cocaine use can be associated with serious cardiovascular complications, including myocardial infarction. Several case reports have recently linked the use of cocaine with ischemic events of the small bowel and colon. We report a case of ischemic colitis complicated by perforation in a 47-yr-old diabetic man which occurred after recreational cocaine use. The older age of the patient and underlying diabetes mellitus were unique aspects of our case, compared with others reported in the literature. The patient's history of cocaine use was not initially identified. After we obtained a negative arteriogram result, we went hack to the patient and the information was revealed. The literature regarding intestinal ischemia related to cocaine and other drugs/medications is reviewed. The abuse of cocaine should he considered in the differential diagnosis of acute intestinal vascular insufficiency syndromes. [ABSTRACT FROM AUTHOR]