Severe vomiting from cannabis hyperemesis caused a rare triple air leak in the chest and abdomen

A 21-year-old chronic cannabis user with cannabinoid hyperemesis syndrome (CHS) developed a rare triad of spontaneous pneumomediastinum (air around the heart's major vessels), pneumopericardium (air around the heart), and pneumoretroperitoneum (air behind the abdominal cavity) from severe vomiting. Initial findings raised concern for Boerhaave syndrome (esophageal rupture), but imaging ruled out perforation. The patient recovered fully with conservative management: bowel rest, IV fluids, electrolyte correction, antiemetics, and antibiotics.

Single case report of a 21-year-old woman presenting with CHS complicated by triple air leak syndrome. Diagnostic workup included imaging to rule out esophageal perforation. Conservative management approach documented with follow-up to full recovery.

This case demonstrates that CHS can produce complications serious enough to mimic surgical emergencies like esophageal rupture. Recognizing this pattern can prevent unnecessary invasive procedures while ensuring appropriate conservative management.

As CHS becomes more frequently recognized, awareness of its rarer complications helps emergency physicians avoid both under-treatment (missing a true perforation) and over-treatment (unnecessary surgery for a self-limiting complication).

Single case report cannot establish frequency or risk factors for this complication. Conservative management worked in this case but may not be appropriate if esophageal perforation cannot be definitively excluded.