Clinical Case Database / Category: Patient Management

Surgical complications related to IV drugs abuse

Publication details

Mr Abdus Saboor Khan Ghauri, Charlotte Rachelle Gould, John Russell Charles Richardson
Foundation Years Journal, volume 9, issue 7, p.47 (123Doc Education, London, July 2015)


Injection drug users (IDUs) not uncommonly present to the emergency department (ED) with cutaneous and vascular complications (1). Although numbers injecting (cocaine and heroine) have fallen (93,401 in 2010-11, 87,302 in 2011-12) (2), hospital admissions due to injection site complications have increased (3). These complications include localised cellulitis, abscess development, pseudoaneurysm (PA) formation, compartment syndrome and necrotising fasciitis (NF) (4). The following case-based discussion exemplifies how a typical intravenous drug user may present; we discuss the important differentials and the challenges faced in managing these complications.

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Mr Abdus Saboor Khan Ghauri (Corresponding author)

Salisbury NHS Foundation Trust
Dept of General Surgery, Salisbury District Hospital,
Odstock Road, Salisbury, Wiltshire, SP2 8BJ

Charlotte Rachelle Gould

Dept of General Surgery, Salisbury District Hospital
Odstock Road, Salisbury, Wiltshire, SP2 8BJ

John Russell Charles Richardson

Dept of General Surgery, Salisbury District Hospital
Odstock Road, Salisbury, Wiltshire, SP2 8BJ


1. Binks, S., Hoskins, R., Salmon, D. & Benger, J. 2005. Prevalence and healthcare burden of illegal drugs among emergency department patients. Emerg Med J. 22(12): 872-873.
2. 2014. Statistics on Drug Misuse, England. [Online] Health and Social Care Information Centre. Available at: [Accessed 09/06/15]
3. Irish, C., Maxwell, R., Dancox, M., Brown, P., Trotter, C., Verne, J. & Shaw, M. 2007. Skin and soft tissue infections and vascular disease among drug users, England. Emerg Infect Dis. 13(10): 1510-1511.
4. Lavender, T.W. & McCarron, B. 2013. Acute infections in intravenous drug users. Clin Med. 13(5): 511-513
5. Coughin, P.A. & Mavor, A.I.D. 2006. Arterial consequences of Recreational Drug Use. Eur J Vasc Endovasc Surg. 32: 389-396
6. Phoenix, G., Das, S. & Joshi, M. 2012. Diagnosis and management of cellulitis. BMJ. 345:e4955
7. Biswanger, I.A., Kral, A.H., Bluthenthal, R.N., Rybold, D.J. & Edlin, B.R. 2000. High prevalence of abscesses and cellulitis among community-recruited injection drug users in San Francisco. Clin Infect Dis. 30(3): 579-581.
8. Blumstein, H. 1993. Retained Needle Fragments and Digital Dissection. N Engl J Med. 328(19): 1426
9. Chen, J.L., Fullerton, K.E. & Flynn, N.M. 2001.Necrotising Fasciitis Associated with Injection Drug Use. Clin Infect Dis. 33(1): 6-15.
10. Waldron, c., Solon, J.G., O'Gorman, J., Humphreys, H., Burke, J.P. & McNamara, D.A. 2014. Necrotising Fasciitis: The need for urgent surgical intervention and the impact of intravenous drug use. Surgeon. [ePub ahead of print]
11. Sultan, H.Y., Boyle, A.A. & Sheppard, N. 2012. Necrotising Fasciitis. BMJ. 345:e4274
12. Tsao, J.W., Marder, S.R., Goldstone, J. & Bloom, A.I. 2002. Presentation, diagnosis and management of arterial mycotic pseudoaneurysms in injection drug users. Ann Vasc Surg. 16(5): 652-662
13. Kotsikoris, I., Papas, T.T., Papanas, N., Tzor-Batzoglou, I., Maras, D., Bessias, N., et al. 2012. Femoral artery pseudoaneurysms in intravenous drug users: a 12 year series. Int Angiol. 31(5): 433-437. 32(4): 397-401.
14. Yegane, R.A., Salehi, N.A., Ghaseminegad, A., Bahrami, F., Bashashati, M., Ahmadi, M. & Hojjati, M. 2006. Surgical approach to vascular complications of intravenous drug abuse. Eur J Endovasc Surg.
15. Jayaraman, S., Richardson, D., Conrad, M., Eichler, C. & Schecter, W. 2012. Mycotic pseudoaneurysms due to injection drug use: a 10 year experience. Ann Vasc Surg. 26(6): 819-824
16. a2014. Health Protection Weekly Report. 4th July 2014. [Online]. Public Health England. Available at: [Accessed 09/06/15]
17. b2014. Shooting Up: Infections among people who inject drugs in the United Kingdom 2013. London: Public Health England, November 2014. [Online]. Public Health England. Available at: [Accessed 09/06/15]
18. Norfolk, G.A., Gray, S.F. 2003. Intravenous drug users and broken needles- a hidden risk? Addiction. 98(8): 1163-1166
19. Ngaage, D.L. & Cowen, M.E. 2001. Right ventricular needle embolus in an injecting drug user: the need for early removal. Emerg Med J. 18(6): 500-501.
20. Monroe, E.J., Tailor, T.D., McNeely, M.F. & Lehnert, B.E. 2012. Needle embolism in intravenous drug use. Radiol Case Rep. 7(3): 714


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