Abstract Introduction With recent changes in legislation regarding the sale and consumption of cannabis, the incidence of Cannabinoid Hyperemesis Syndrome (CHS) across emergency departments in the USA has increased, with adolescents and young adults accounting for a significant portion of cases. While long term outcomes with supportive therapy and cannabis cessation are favorable, rare complications such as pneumomediastinum have been described in case reports, emphasizing the need for increased vigilance in at-risk populations. Case Report A 19-year-old male presented to the hospital with complaints of severe abdominal pain and vomiting with epigastric pain radiating to his neck. He reported smoking cannabis daily since the age of 15 and experiencing prior cyclic episodes of emesis. He denied fever, chills or dyspnea. Vital signs were unremarkable with physical examination notable for abdominal tenderness, most pronounced over epigastrium and anterior cervical crepitus. Laboratory workup revealed no leukocytosis, mild hypokalemia and negative lipase level, urine drug screening was declined. CT imaging of Chest, Abdomen and Pelvis with IV contrast demonstrated moderate pneumomediastinum extending into the thoracic inlet and mild gastroesophageal junction inflammation. A modified barium swallow (MBS) was performed, ruling out esophageal perforation. The patient was admitted for observation and conservative management of spontaneous pneumomediastinum (SPM) due to CHS. He was treated with antiemetics and abdominal capsaicin cream and referred for substance use counseling. Discussion CHS is clinically diagnosed by history of chronic cannabis use and recurrent episodes of abdominal pain paired with emesis and relieved by hot water bathing. The mechanism of CHS is not fully understood. Downregulation of CB1 receptors in the setting of chronic cannabinoid exposure, inhaled route and the increased levels of Tetrahydrocannabinol (THC) in newer cannabis strains are considered contributing factors. Earlier age at onset of use in adolescents and young adults is an additional risk factor for developing CHS. SPM is more common in younger patients in response to certain triggers like recurrent forceful emesis. Both SPM and esophageal perforation can be complications of cyclic emesis. Esophageal perforation is associated with hemodynamic instability and can be ruled out with oral contrast studies. SPM without dyspnea or hypoxia is treated conservatively with serial monitoring and avoidance of valsalva provoking maneuvers. This report aims to highlight a rare complication of a popular recreational drug and to underscore the increased risk to younger populations for both experiencing CHS and developing severe complications like SPM. This abstract is funded by: None
Szamosfalvi et al. (Fri,) studied this question.