Unusual side effect of cannabis use: acute abdomen due to duodenal perforation

Abstract

Background: The chronic use of synthetic cannabinoids (SCs) which has become an increasingly prevalent problem can rarely cause gastric and duodenal ulcer because of their effects on gastric secretion and emptying. Since peptic ulcer disease (PUD) is a rarely seen entity in patients who consult to the emergency service with complaints of abdominal pain, most of the physicians do not suspect of this clinical diagnosis. Perforation is a mortal complication of PUD, and early diagnosis and emergency surgery are life-saving procedures. Case presentation: A 16-year-old male patient was referred to our emergency service from another center with abdominal distension, complaints of abdominal pain, and bilious vomiting. His medical history revealed that he had been regularly using bonsai for the past 3 years. Plain abdominal radiograms of standing position revealed subdiaphragmatic free air, then we performed laparotomy which disclosed perforation of the first part of the duodenum. Surgical intervention with omental patch and primary closure (Graham patch) was successful. The patient who underwent nasogastric decompression and received antibiotherapy had not experienced any complication during the postoperative follow-up period. Conclusion: Herein, as an unusual manifestation, a patient who developed duodenal perforation following chronic SC use has been reported. In adolescent patients admitted with PUD or its complications to the emergency services, it is important to inquire for the use of addictive substances which are increasingly prevalent in order to determine the etiology.

A Case of Cannabinoid Hyperemesis Syndrome with Heliobacter Pylori and Preeclampsia during Pregnancy

“…The specific gastrointestinal lesions in subjects with chronic cannabinoid consumption are due to a chronic delay in gastric emptying and consist of ischemia and peptic ulcer disease reported as single cases in the literature. 30 , 31 Interestingly, H. pylori infection is one of the predisposing factors to peptic ulcer disease. Thus, H. pylori could represent the mechanism underlying the development of peptic ulcer disease in individuals with chronic cannabinoid consumption.…”

Fatal Mesenteric Ischemia Induced by Synthetic Cannabinoids: A Case Report and Literature Review

“…Furthermore, gastrointestinal involvement was found as well. Buyukbese Sarsu described a young patient who developed duodenal perforation as a complication of a peptic ulcer disease, following chronic SC use [ 23 ]. Sevinc et al reported a very rare case of acute gastric dilatation (AGD) and hepatic portal venous gas (HPVG) with findings of acute abdomen resulting from chronic use of a SC [ 24 ].…”

Cannabis Use and Associated Gastrointestinal Disorders: A Literature Review

“…Similarly, a study done by Zhang P., Huang Y., Hao H., et al found that THC inhibited the migration of keratinocytes, which are the cells responsible for closing wounds. This study also found that THC decreased the production of collagen, which is necessary for wound healing and tissue repair [ 26 ].…”

“…Some studies have linked cannabis use with an increased risk of post-endoscopic retrograde cholangiopancreatography (ERCP)-induced pancreatitis [ 22 , 24 , 25 ]. Studies show that people under age 35 who use cannabis recreationally or for certain medical reasons are at increased risk for pancreatitis [ 22 , 23 , 26 , 27 ]. Although most studies show an increased overall incidence of AP with cannabis use, some other studies have documented improved outcomes in AP patients using cannabis when compared to non-users.…”