A case of cecal infarction proximal to an obstructing fecaloma is presented. The patient's medical records revealed a 19-year history of the abuse of prescribed narcotic, sedative, psychotropic, and anticholinergic drugs. Gangrene in this case was caused by compression of intramural vessels secondary to a sustained increased in intracolonic pressure. The greatest effect of this increased pressure was found in the cecum, where wall tension and colonic distention were greatest. This report indicates that the colonic effects of chronic drug abuse have the potential for becoming a true surgical emergency.