Ischemic enterocolitis is a well-recognized entity occurring in cocaine users. Diagnosis is based on the presence of rectal bleeding, abdominal pain, a history of cocaine use, supportive endoscopic and histopathologic findings, and the absence of other etiologic mechanisms of ischemic colitis. In this study, we evaluated endoscopic and histopathologic findings in seven patients with cocaine colitis. Lesions seen by endoscopy, which were restricted to the left colon, included hemorrhagic edematous mucosa, pseudopolyps, and ulcerations. Rectal involvement, not a common feature of ischemic colitis, was seen in five patients. In two patients histologic lesions were classified acute/subacute, and in three patients as subacute/chronic. In the remaining two patients lesions were combined acute/subacute and chronic. The presence of subacute/chronic lesions suggested recurrent ischemic episodes and could reflect repeated use of cocaine. Future studies will be needed to define the long-term clinical and histopathologic significance of these subacute/chronic lesions.