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Following intake of the drug, abusers develop abdominal pain and tenderness. There may also be associated nausea, vomiting and bloody diarrhoea. The onset of symptoms may be within an hour following drug abuse but the presentation may be delayed by up to 48 hours. The diagnosis of an acute abdomen may be difficult and requires a high index of clinical suspicion, especially as there may be no abnormal findings on imaging investigation such as free intraperitoneal air.5 The abdominal complication of cocaine and crack differ slightly and these are discussed separately.