State University of New York Health Sciences University Hospital Brooklyn, NY
Daniel Yeoun, DO, MPH1, Cherif El Younis, MD2, Yasir Ali, MD2, Muhammad F. Ahmed, MD2; 1State University of New York Health Sciences University Hospital, Brooklyn, NY; 2Brookdale University Hospital, Brooklyn, NY
Introduction: Chronic use of cannabis has been associated with frequent and typically self-limited episodes of cannabinoid hyperemesis syndrome. Few cases of transient intussusception have been reported among chronic cannabis users. We report a case of a chronic cannabis user presenting with long-segment intussusception that required intestinal resection.
Methods: A 54 year old woman, chronic cannabis user, presented with diffuse, cramping abdominal pain. She had prior emergency room visits for similar mild symptoms. Patient denied taking any medications and never had surgery or endoscopy. She used cannabis daily for many years. Examination was remarkable for a soft, mildly distended abdomen with mild diffuse tenderness. Her complete blood count, metabolic panel, electrolytes, lactate, thyroid studies, hemoglobin a1c, HIV, stool tests and pregnancy test were unremarkable. Urine toxicology was cannabinoid positive several times over the past year. CT of the abdomen revealed a long-segment ileocolonic intussusception extending to the mid-transverse colon and she was taken for emergent laparotomy. Intraoperatively, there was no necrosis or masses identified. Due to the long-segment intussusception, she received a right hemicolectomy. She had an uneventful post-operative course. Discussion: Adult idiopathic intussusception without an identifiable lead point is exceedingly rare. A few case reports have associated intussusception with chronic cannabis use as a possible cause. Chronic cannabis use disrupts gastrointestinal motility and slows peristalsis in various bowel segments through chronic activation of cannabinoid receptor type 1 (CB1) located in the submucosal and myenteric nerve plexus. In all similar cases reported among chronic cannabis users, intussusception was transient and reversible. In the case we present, intussusception did not resolve with conservative management and required right hemicolectomy.
In patients presenting with intussusception, a complete work-up is necessary to rule out structural abnormalities including malignancy. Intussusception related to chronic cannabis use may be transient and potentially preventable with cessation of cannabis. With the growing use of cannabis worldwide, more complications of cannabis use will be recognized. Awareness of chronic cannabis use as a possible etiology of adult intussusception is important as a potentially preventable and reversible etiology of intussusception.
A) XR one month prior to intussusception diagnosis; B) Five days prior to surgery there is interval bowel dilation
Axial, coronal, and sagittal views of a long-segment ileocolonic intussusception. Mesenteric fat, vessels, and the appendix can be visualized within the intussusception.
Disclosures: Daniel Yeoun indicated no relevant financial relationships. Cherif El Younis indicated no relevant financial relationships. Yasir Ali indicated no relevant financial relationships. Muhammad Ahmed indicated no relevant financial relationships.