Rolling up Trouble: Adult Intussusception Possibly Sparked by Cannabis Use or Pheochromocytoma

Intussusception is a rare phenomenon in adults which is typically associated with neoplasms, post-operative adhesions, strictures, inflammatory bowel diseases, and endometriosis. With the rise of legalization and widespread use, a growing body of evidence has emerged suggesting a possible association between cannabis use and intussusception in adults. We describe a case of a middle-aged male with a history of uncontrolled hypertension and regular marijuana use who presented with intussusception and was incidentally found to have an adrenal nodule with laboratory evidence strongly suggestive of pheochromocytoma. Through our investigation, the culprit cause of the intussusception could not be fully elucidated due to the patient eloping. The link between cannabis and intussusception lies in the hypothesis that activation of cannabinoid receptors in the enteric system results in inhibition of acetylcholine release in presynaptic neurons leading to slowed contractile activity and peristalsis, establishing a point for invagination leading to intussusception. Meanwhile, the incidental adrenal nodule could have possibly contributed to the intussusception in two different ways. The mass effect of an adrenal nodule or its nearby metastasis could have served as a classic lead point. The other means revolve around the suspected pheochromocytoma producing excess catecholamines, which, like cannabinoids, also slow contractile activity and peristalsis. This case demonstrates how a more thorough diagnostic evaluation may be warranted in cases of intussusceptions in adults and highlights how cannabis use and pheochromocytoma may have been two potential predisposing risk factors.