A 21-year-old woman with cannabinoid hyperemesis syndrome developed spontaneous pneumomediastinum, pneumopericardium, and pneumoretroperitoneum from severe vomiting, initially raising concern for esophageal rupture.
Emergency medicine physicians, gastroenterologists, critical care clinicians
Triple air leak resolved with conservative management alone
What the researchers found
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.
Why it matters
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.
The numbers in context
21-year-old female; triple air leak: pneumomediastinum + pneumopericardium + pneumoretroperitoneum; full recovery with conservative management
How the study worked
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.
What this study cannot tell us
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.
How to read the evidence
Single case report provides the lowest level of clinical evidence but documents a rare and clinically important complication pattern.
When this study was published
2025 publication
The bigger picture
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).
Questions still open
- How often do CHS patients develop air leak complications? Are there clinical features that reliably distinguish CHS-related air leaks from esophageal perforation without imaging?
Common questions
What is a triple air leak syndrome?
Was surgery needed?
Read the original research
Triple Air Leak Syndrome in Cannabinoid Hyperemesis: A Diagnostic Challenge Managed Conservatively.
ACG case reports journal, 12(10), e01858
Citation
Ali, Kashif; Masood Shah, Aresha; Hyder, Arsalan; Balderas, Valeska. (2025). Triple Air Leak Syndrome in Cannabinoid Hyperemesis: A Diagnostic Challenge Managed Conservatively.. ACG case reports journal, 12(10), e01858. https://doi.org/10.14309/crj.0000000000001858